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- Wit l <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD,YYYY) <br />06Y25/2012 <br />F <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 holder in lieu of such endorsement(s). <br />PRODUCER <br />Aon Risk Services Northeast, Inc. <br />New York NY Office <br />CONTACT <br />NAME: <br />PHONE (866) 283-7122 FAX (847) 953-5390 <br />(A/C. No. Ext): (AIC. No.): <br />199 water street <br />New York NY 10038-3551 USA <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />ICF Jones & Stokes, Inc. <br />9300 Lee Highway <br />Fairfax VA 22031-1207 USA <br />INSURER A: AXIS Surplus Insurance Company <br />26620 <br />INSURERB: Great Northern Insurance Co. <br />20303 <br />INSURER C: Sentry Ins A Mutual Company <br />24988 <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />uuv!CKN"N f:FK11F I1:01F NIIM FiF K• h/11114H /Yra /_{/ RF\/1 CI(l1U mllmuGip• <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. Limits shown are as requested <br />LTR <br />TYPE OF INSURANCE <br />INSR <br />WVD <br />POLICY NUMBER <br />MMIDD <br />MMIDDM/YY <br />LIMITS <br />B <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X❑ OCCUR <br />Package - Domestic <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$1,000,000 <br />M E D E X P (Any one person) <br />$10, 000 <br />X Prod -Comp Op Incl in Gen'I Agg <br />PERSONAL & ADV INJURY <br />$1,000,000 <br />X <br />Contractual Liability <br />GENERAL AGGREGATE <br />$2 , 000, 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />X POLICY PRO- LOC <br />JECT <br />B <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />73522955 <br />-,_K1(((T���IStates <br />/ <br />/ MO� <br />•/� <br />06/2 52012 <br />AS TO FORM <br />06/25 2013 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />BODILY INJURY ( Per person) <br />J$1,000,000 <br />XAutomobile <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS N NON -OWNED <br />AUTOS <br />i <br />G (- <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />(Per accident) <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />j�(�(� <br />-■�v <br />AGGREGATE <br />EXCESS LIAR <br />CLAIASSddADE <br />{/ <br />�• <br />n <br />ity Alto <br />ey <br />y <br />DED RETENTION <br />C <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR / PARTNER 1 EXECUTIVE <br />OFFICER/MEMBEREXCLUDED? F71 <br />NIA <br />90-17657-01 <br />Workers Comp <br />90-17657-02 <br />06 25 2012 <br />06/25/2012 <br />06/25/2013 <br />06/25/2013 <br />WC STATu- OTH- <br />X TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />workers Comp <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />A <br />E&O-MPL-Primary <br />EBZ 768043/01/2012 <br />Errors & omissions <br />06/25/2012 <br />06/25/2013 <br />Prof Liab Agg - All <br />Overall policy aggr, <br />$1,000,000 <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />1 - Professional Liability is a Claims Made policy. There is no Additional Insured status on the Professional Liability <br />coverage. <br />2 - The City of Santa Ana, its officers, agents, volunteers and employees are included as Additional Insureds as their interest <br />may appear. <br />3 - subject to the standard terms and conditions of the individual policies, the indicated coverage is primary and <br />larf l It-IGAI It MULUtrt CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City Of Santa Ana AUTHORIZED REPRESENTATIVE <br />Planning Division, M-20 <br />20 Civic Center Plaza <br />Post office Box 1988 �/J i%LC c/t L2rcrD (/ if <br />Santa Ana, CA 92702 USA <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />`m <br />O <br />2 <br />N <br />M <br />u=. <br />r <br />d <br />U <br />