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�1 <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />06/14/2011 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />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 the <br />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 holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />Myoho Insurance Services, Inc. <br />NAME: <br />PHONE FAX <br />2090 N. Tustin Ave. Suite 250A <br />AIC No <br />E -MAIL <br />Santa Ana, CA 92705 <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />T.(714) 543 -3500 F.(714) 543 -7160 <br />INSURER A: Travelers CasuaIt Insurance Com an ofAmerica <br />y one person) <br />$ 5 000 <br />INSURED <br />Anaheim Chamber of Commerce <br />INSURER B : Employers Compensation Insurance Com an <br />S 2000,000 <br />INSURER C: <br />201 East Center Street <br />INSURER D: <br />Anaheim, CA 92805 <br />INSURER E: <br />INSURER F: <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />X POLICY prca LOC <br />- - - -- - ---- '-- '-' --'° nEmVIJIVIY I1jUIVI6CK: <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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1NSR ADOL SUBR <br />LTR TYPE OF INSURANCE POLICY NUMBER MM DIDY♦YEYW MM1DDlYY tYY LIMITS <br />GENERAL <br />LIABILITY <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE a OCCUR <br />�rx <br />/ <br />1680- 3961X479 - ACJ -11 <br />03/11/2011 <br />03/11/2012 <br />RRENCE <br />$2,000,000 <br />REN E <br />a occurrence <br />E <br />$ 300 000 <br />y one person) <br />$ 5 000 <br />ADVINJURY <br />S 2000,000 <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />X POLICY prca LOC <br />PRODUCTS - COMPIOPAGG <br />$4000,000 <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON-OWNED <br />HIRED AUTOS X AUTOS <br />F_ <br />r <br />F_ <br />I -680- 3961X479 - ACJ -11 <br />03/11!2011 <br />03/11/2012 <br />IN <br />COMBED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPER TY DAMAGE <br />Peracc(den <br />$ <br />Hired & Non -Owned <br />$ Included <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />_ <br />N/A <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION 5 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN <br />OFFICE/MEMBER EXCLUDED? <br />(Mandatory in ❑ <br />If yes, describe under <br />B <br />NIA <br />�, <br />EIG- 1344753 -00 <br />06/08/2011 <br />06/08!2012 <br />WC STATU- OTH- <br />r LIMITS <br />E.L. EACH ACCIDENT <br />$ 1 000 000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000000 <br />E.L. DISEASE- POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPrEATIONS below <br />A <br />BPP <br />(Replacement Cost/ Special Form) <br />1 -680- 3961X479 - ACJ -11 <br />03/11/2011 <br />03/11/2012 <br />$76,000 / Ded $1,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mare space is required) <br />(30 -day notice of cancellation except for 10 -day notice of cancellation for non - payment). <br />The following is named as an additional insured: Santa Ana Work Center, 1000 E. Santa Ana Blvd., #200, Santa Ana, CA 92701. This additional insured is <br />subject to the policy terms, conditions, limitations, and exclusions in respect to liability arising out ofAnahei�� amber of Commerce's operations. <br />TQFCa <br />O "VEp <br />AppR S <br />CFRTIP1Ce7C unl nco _ _ _ _ __.�, <br />Clerk of the Council / City of Santa Ana <br />20 Civic Center Plaza (M -30) <br />P.O. Box 1988 <br />Santa Ana <br />CA 92702 -1988 <br />M(3UtV'KNY 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 c� � <br />w 1 Woa -Ltll u AL UKL) UuKI'LI CATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />