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'_i?ORD? CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/1/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: M1 Ckiel le GOOdw1n Int erWe St In SllranCe SerV1 Ce5 PHONE AX License #OB01094 aG No Ext: - - A/G No: 222 Court S£reet E-MAIL ADDRESS: SR oodwi nOi wins com Woodland CA 95695 PR DU ER CUSTOMER ID Y: US HEA- 1 INSURER(S) AFFORDING COVERAGE NAIC N INSURED INSURERA:SCOttSdale Insurance CO. 41297 U. S. Heal tklwor)cs, Inc. INSURER e:Sa£et National Ca sualt Cor 15105 25124 Springfield Ct. Ste 200 Valencia CA 91355 INSURERC:St. Paul Fire & Marine Ins Co INSURER D:Travelers Pro ert Casua It 25674 INSURER E INSURER F !?l1VCOA/'_CC I?OeT,c,/+w TC wu ,wwcce. ..? ?.-.-."?.?.? .-. ?. ......... ?. ?... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREM EN T, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS /'- GENERAL LIABILITY Y BC50022924 9/1/2010 9/1/2011 EACH OCCURRENCE g1, 000, 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oecunence $300,000 CLAIMS-MADE ? OCCUR MED EXP (Any ona person) $10, 000 PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO X LOC $ D AUT OMOBILE LIABILITY Y BA9490R699 9/1/2010 9/ 1/ 20 11 COMBINED SING LE LIMIT $1000 000 ANY AUTO ? T ? I , O t+ ?+ l? i y BODILY INJ URY (Per person) $ SCH EDULED AUTOS p wE? J BODILY INJURY (Per accitlant) $ X HIRED AUTOS Ap (PerOa cden[DAMAGE $ X NON-OWNED AUTOS E ST ORCK $ ,,Sp' 1t P`?Dr 6y $ C UMBRELLA LIAB X OCCUR QK09101752 AS 9/1/2010 9/1/2011 EACH OCCURRENCE $20,000,000 EXCESS LIAB CIAIMS-MADE AGGREGATE $20, 000, 000 DEDUCTIBLE ?. $ RETENTION $ iii $ g WO AND RKERS COMPENSATION EMPLOYERS' LIABILITY LDC4042721 9/1/2010 9/1/2011 X WC STATU- DTH- Y / N ANV PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCL DED? ? N / A E.L. EACH ACCIDENT $1, 000, 000 U (Mantlatory in NH) E. L. DISEASE-EA EMPLOYE $1,000,000 If yes, tlescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATONS /VEHICLES (Attach ACORD 10t, AdtlHlonal RemaACa sehetlule, H more apace Is requlretl) v Crc I Ir II.A 1 C nvt_uCn GANGCLLA 11(7N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City o£ Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTA]TI'7VE v?J/ /t/•,.G..? r ?_ ?_ ©'1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD