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OP ID• HILA <br />'4??°?O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) <br /> 06/01/11 <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(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate ho)der Fn lieu of such endorsements . <br />PRODUCER 714-436-6400 CONTACT <br />NAME; Laura Hicks <br /> <br />Schweickert $ Company 714-436-6499 <br />15 P <br />t <br />C <br />R __ <br />PNONE 714-6.89-,177.1 F c <br />--.-_--_ LAl?NOI: 714-436-6498 <br />e <br />ers <br />anyon <br />oad <br />Irvine <br />CA 92606 E?MAIL <br />ADDRESS: !aura schweickert.com <br />.. <br />, __.._ <br />__,__ _. <br />PR D ER OCHUM <br />1 <br /> - <br />C TOMER ID #: <br /> <br />_ _.-__.. <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSVREO OC Human Relations Council INSVRERA-PhIladBlphla Insurance Co?any_,__ 18058 <br />Attn: Shari Wingate INSURER B : <br /> <br />1300 S. Grand Ave., Bldg B _ <br /> INSURERC: <br />Santa Ana, CA 92705 <br /> INSURER D : _ <br /> _ _ <br />INSURER E <br />-_ <br /> INSURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NIIMRF12e <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 />CE RTIFlCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOR DEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 6Y PAID CLAIMS. <br />I T R TYPE OF INSURANCE POLICY NUMBER M DD/YY YY MM/ODry YYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE <br />-. S 1,000,00 <br />_. ___ <br />A X COMMERCIAL GENERAL LIABILrTY <br />_._ X PHPK545799 04/28H1 04!26!12 6A?AGE T6-RENTE?- <br />pREMiSg?Ea occurrence) 5 100,00 <br /> <br /> <br />_- <br />CLAIMS'-MADE ? OCCUR . <br />-__ <br />MEO EXP (Any ons?rsoni <br />- - ___ <br />S 5,00 <br />- <br /> PERSONAL SADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE 5 2,000,00 <br /> GEN'L AGGREGATE L]h11T APPLIES PER: PRODUCTS -COMP/OP AGG S 1,000,00 <br /> POLICY PRO LOC 5 <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,00 <br /> PHPK545799 04/26H 1 04/26/12 <Ea accldenq <br /> <br />A <br />X ANY AUTO BODILY INJURY (Per person) 5 <br /> ALL OWNED AUTOS 99 FORD VAN Yf93611 BODILY INJURY (Per eccidenp 5 <br /> SCH EDIILE? AUTOS PROPERTY DAMAGE <br />$ <br />A X HIRED AUTOS PHPK545799 04/26/11 04/26/12 (Per accldenf) <br />A X NON-OWNEUAVTOS PHPK545799 o4/zsnl 04!26/12 s <br /> --- $ <br /> UMBREL[A LIAB OCCUR ai+O t? R? EACH OCC URRENCE _ $ __ <br /> EXCESS LIAR CLAIMS-MADE APPROVED A 1 _a. _ <br />AGGREGATE 5 <br /> <br />_ ___ _ <br />DEDUCTIBLE ___ _ <br />S <br /> RETENTION 5 - $ <br /> WORKERS COMPENSATION ) WC STATU- OTH- <br /> AND EMPLOYERS' LIABILITY ... <br /> Y/N t Cit Attorne <br /> ANY PROPRIETOR/PARTNER/EXECUTNE <br />? <br />N / A ,Assistan E.L EACI{gCCIDENT S <br />------ - - <br /> OFFICER/MEMBER FXCLUDEDP / -- -- ---- <br /> (Mentlalory In NH) / E.L. DISEASE - EA EMPLOYEE $ <br /> 11 yes desuibe under <br />OESLIRIPTION OF OPERATIONS below ? -- --- - - - <br />E.L. DISEASE -POLICY LIMIT - -_-- <br />5 <br />/? Balsiness Property PHPK5467B9 04!26/11 04/26/12 Coverage TO,00 <br /> Dedafcti b! 50 <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (AHach ACORD 101, Addlllonal Ramarka Bcheduf e, 1f more space I5 required) <br />The Community Redevelopment Agency of the City of Santa Ana, The City of <br />Santa Ana, 20 Clvlc Center Plaza, M-37, Santa Ana, CA 92701: it's officers, <br />Employees, Agents and Volunteers are named as Additional Insureds with <br />re <br />ard to liability and defense of suit <br />i <br />fr <br />m the o <br />i <br />eratio <br />d <br />g <br />p <br />s ar <br />s <br />n <br />o <br />ns an <br />see erformed b or on behalf of th <br />ctK 1 IrICA I f= HOLDt=K GANG ELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Communit Redevelo ment A enC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Y P 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. <br />of the Clty of Santa Ana <br />City of Santa Ana AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza M-37 f?.? ?! ? ? ?" <br />Santa Ana, CA 92701 ? to . r AQ? ? 1-.Y-[-. c=.le4? <br />© 1986-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD