|
yr IU: rL,
<br />1416-. � CERTIFICATE OF LIABILITY INSURANCE DAT09127OtYYYY)
<br />a9l27/10
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(fes) must be endorsed. If SUBROGATION 1S WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on tills certificate does not confor rights to the
<br />certificate holder In Ileu of such endorsements .
<br />PRODUCER 626-405-6031 CONTACT
<br />NAIAE:
<br />Chapman 626405-0585 PHONE IFAX
<br />A/C No
<br />License #0522024 EMAIL --
<br />P. O. Box 5455 POOR
<br />-PRSTO PRODUCER .INTER-5
<br />Pasadena, CA 91117-0455
<br />-House-Account ,___,_,,, —_,_ INSURER(S) AFFORDING COVERAGE _ HAIC#
<br />INSURED Interval House -INSURER A: Riverport Insurance Company _ 36684
<br />P.O. Box 3356 114SURER El: Everest National 10120
<br />Seal Beach, CA 90740 -
<br />INSURER C
<br />INSURERO;—
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMRFR_ RFVlCJAIU WFIMRPR•
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH H POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LT9
<br />TYPE OF INSURANCE
<br />A�
<br />POLICY NUMBER
<br />P u Y YY
<br />Pf d(OD YY
<br />UIdnS
<br />A
<br />GENERAL LIABILITY
<br />X coMMERCt4LGENERAL LIABILITY
<br />CLAlA1S-MADE a OCCUR
<br />X
<br />RIC0011318
<br />10/01/10
<br />10/01/11
<br />OCCURRENCE
<br />S 1,000,000
<br />_E_ACH
<br />PREMISES Eaoccarre�nce
<br />$ T 100,000
<br />MED EXP (Any one arson)
<br />S 5,000
<br />X Professional Llab _ _
<br />PERSONAL &ADV INJURY
<br />S 1,000,000
<br />X
<br />Sexual Abuse Liab
<br />_
<br />GENERAL AGGREGATE
<br />$ 3,000,0()0
<br />+r O F
<br />i�'�
<br />GENLAGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS_-_CO_MPIOP AGG
<br />S 3,000,000
<br />POLICY PRO- LOC
<br />hJ
<br />Prof Liab
<br />$ 1rn11/3mif
<br />AUTOMOBILE
<br />LIABIUTY
<br />ANY AUTO--
<br />ALLOWNEDAUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />�, �,TOIRGGY*
<br />t,SA t pity Attars
<br />�$$t$tan [/
<br />.- J[
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)---.,
<br />------
<br />S
<br />BODILY INJURY(Per person)
<br />S
<br />BODLYINJURY (Per ac�derq)
<br />S
<br />PROPERTY DAMAGE
<br />(Per aaident)
<br />_—
<br />S
<br />-
<br />14ON-OVMEDAUTOS-
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />S 2,000,00
<br />A
<br />X
<br />EXCESS LIAB
<br />-------
<br />CLAIMS -MADE
<br />----
<br />REL001319
<br />10/01110
<br />10101111
<br />AGGREGATE
<br />$ 2,000,000
<br />_
<br />DEDUCTIBLE
<br />IS
<br />---
<br />$
<br />X
<br />RETENTION S
<br />B
<br />MJIDE/APLOYEORKERSIRSEUABILIITY YIN
<br />ANY PROPRIETORIPARTNFR/EXECUTNE
<br />OFFICERIMEMBEREXCLUDED? Li
<br />(Mandatory In NH)
<br />Ifes, descrIme under
<br />DESCRIPTIONOFOPERATIONS belarr
<br />NIA
<br />6600000287101
<br />02101H0
<br />02101/11
<br />X TORY WC L12,gT OTH-
<br />X
<br />E.L EACH ACCIDENT
<br />S 1,000,000
<br />E.L DISEASE -EAEMPLOYE
<br />S 1,000,000
<br />E.LDISEASE- POLICY LIMIT
<br />S 1,000,000
<br />A �Property
<br />Coverage
<br />RIC0011318
<br />10/01/10
<br />10101/11
<br />Bikt Cant 420,00
<br />A
<br />Crime Coverage
<br />RICOD11318
<br />10/01/10
<br />10I01/11 1EMPIDIS11
<br />200,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is requlmd)
<br />Re: Contract #A-2010.061.002; A-2009-133; A-2009-133A. City of Santa Ana,
<br />its officers, employees, agents volunteers and representatives are named
<br />additional Insured with respecito the General Liability policy ofthe named
<br />his ured - CG 2026 endorsement to follow. Such Insurance Is primary and
<br />non-contributeendorsement to follow. Contd...
<br />CITY016
<br />City of Santa Ana
<br />Community Dev. Agency (M-25)
<br />Attn: Frank Hernandez
<br />20 Civic Center Plaza, M-26
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />&u " —
<br />m 1988.2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|