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117 <br />AccRra CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD1YYYY) <br />12/1212012 <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(les) 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, Inc of Florida <br />1001 Bri ckel l Bay Drive <br />CONTACT <br />NAME: <br />(A/CNN _ Ext): (866) 283-7122 FAX No.: (847) 953-5390 <br />suite 1100 <br />Miami FL 33131 USA <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED <br />INSURER A: National Union Fire Ins Co of Pittsburgh 19445 <br />G4S Secure Solutions (USA) Inc. <br />1395 University Blvd <br />Jupiter FL 33458 USA <br />INSURER B: New Hampshire Ins Co 23841 <br />INSURER C: Illinois National Insurance Co 23817 <br />INSURER D: <br />INSURER E: <br />` �---- <br />INSURER F: <br />COVFRAGFS CFRTIFICOTF NIIMRFR• h/(1(14H_3/H1hfl) RFVISIC7N NIIMRFR• <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'W <br />LIMITS <br />A <br />GENERAL LIABILITY <br />GL7146406 <br />EACH OCCURRENCE $5,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />PREMISES Ea occurrence $5,000,000 <br />CLAIMS -MADE X❑ OCCUR <br />MED EXP (Any one person) Excluded <br />PERSONAL & ADV INJURY $5,000,000 <br />GENERAL AGGREGATE $5,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG $5,000,000 <br />X POLICY PRO- LOC <br />A <br />AUTOMOBILE LIABILITY <br />CA 344-72-19 <br />10 01 2012 <br />10 Ul 2013 <br />COMBINED SINGLE LIMIT $5,000,000 <br />Ea accident <br />AOS <br />BODILY INJURY( Per person) <br />B <br />X ANY AUTO <br />CA 344-72-20 <br />10/01/2012 <br />10/01/2013 <br />ALL OWNED SCHEDULED <br />MA <br />BODILY INJURY (Per accident) <br />A <br />AUTOS AUTOS <br />CA 344-72-21 <br />10/01/2012 <br />10/01/2013 <br />HIRED AUTOS NON -OWNED <br />VA <br />PROPERTY DAMAGE <br />Per accident) <br />AUTOS <br />UMBRELLA LIAB <br />EACH OCCURRENCE <br />EXCESS LIAB <br />HOCCUR <br />CLAIMS -MADE <br />AGGREGATE <br />DED TENTION <br />B <br />WORKERS COMPENSATION AND <br />wc043464615 <br />10/01/2012 <br />10701720-13 <br />XWC STATU- OTH- <br />TORY LIMITS ER <br />EMPLOYERS' LIABILITY YIN <br />ADS <br />E.L. EACH ACCIDENT $1,000,000 <br />ANY PROPRIETOR; PARTNER / EXECUTIVE <br />A <br />OFFICER/MEMBER EXCLUDED? <br />N I A <br />WC043464616 <br />10/01/2012 <br />10/01/2013 <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />(Mandatory in NH) <br />CA <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />I E.L. DISEASE -POLICY LIMIT $1,000,000 <br />A <br />Excess WC <br />XWC663613410/01/2012 <br />10/01/2013 <br />EL Each Accident $1,000,000 <br />OH -Statutory WC <br />EL Disease - Policy $1,000,000 <br />SIR applies per policy ter <br />s & conditions <br />EL Disease - Ea Emp' $1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Contract Name: Agreement for Provision of security Guard services; Service: Security Guard Services; G4s Office: LAN. The City <br />of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insured with regards <br />to the General Liability policy. The policies evidenced herein are primary and non contributory to other insurance available to <br />the certificate holder, but to by <br />only the extent required written contract with the insured. This insurance shall not be <br />cancelled, or materially reduced in coverage or limits except after 30 days written notice has been given to the city of Santa <br />Ana. <br />APPROVED AS TO FORM <br />CERTIFICATE HOLDER c���%i - 1 1, . CANCELLATION <br />/ v C LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Laura SLlt 1t e -d EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />The City Of Santa Ana Assistant City Attorney AUTHORIZED REPRESENTATIVE <br />20 Civic center Plaza <br />Santa Ana CA 92701 USA <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />N <br />u7 <br />m <br />n <br />M <br />CD <br />C) <br />r - <br />Ln <br />