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ACS ® <br />CERTIFICATE OF LIABILITY INSURANCE <br />DAT 03131/2011Y�) <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 />(Ac. No. Ext): (866) 283 -7122 A/C. No.: (847) 953 -5390 <br />E -MAIL <br />ADDRESS: <br />199 Water Street <br />New York NY 10038 -3551 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIC 9 <br />GL <br />INSURED <br />INSURER A: Mitsui Sumitomo Insurance USA Inc. <br />22551 <br />NEC Corporation Of America <br />6555 N. State Highway 161 <br />INSURER B: Mitsui Sumitomo Insurance CO of America <br />20362 <br />INSURER C: <br />Irving TX 75039 -2402 USA <br />INSURER D: <br />DAMAGE TO RENTED <br />INSURER E: <br />X COMMERCIAL GENERAL LIABILITY <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 570042001100 REVISION NUMBER: <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 />MMIDDlYYYY <br />MWDDIYYYY <br />LIMITS <br />B <br />GENERAL LIABILITY <br />GL <br />EACH OCCURRENCE <br />$1,000,000 <br />General Liability <br />DAMAGE TO RENTED <br />$250, 000 <br />X COMMERCIAL GENERAL LIABILITY <br />PREMISES Ea occurrence <br />CLAIMS -MADE ❑X OCCUR <br />MED EXP (Any one person) <br />$10,000 <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$1,000,000 <br />X POLICY PRO LOC <br />• <br />AUTOMOBILE LIABILITY <br />BVR 8000052 <br />04/01/2011 <br />04 01 2012 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />Business Auto Coverage -A <br />BODILY INJURY ( Per person) <br />• <br />ANY AUTO <br />BVR 8302206 <br />04/01/2011 <br />04/01 /2012 <br />ALL OWNED SCHEDULED <br />Business Auto PA <br />BODILY INJURY(Per accident) <br />A <br />AUTOS AUTOS <br />JX <br />BVR 8405080 <br />04/01/2011 <br />04/01/2012 <br />HIRED AUTOS X NON -OWNED <br />BUST tress Auto- Massachuset <br />PROPERTY DAMAGE <br />(Per accident) <br />AUTOS <br />Comp /Coll Ded <br />$1,000 <br />B <br />X <br />UMBRELLA LAB <br />X <br />OCCUR <br />UM65000098 <br />04/01/201104/01 <br />/2012 <br />EACH OCCURRENCE <br />$5,000,000 <br />Excess Umbrella Coverage <br />AGGREGATE <br />$5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />SIR applies per policy terns <br />& condi <br />ions <br />DE❑ X RETENTION 410,000 <br />B <br />WORKERS COMPENSATION AND <br />WCP9102225 <br />04 01 201104/01 <br />2012 <br />X I WC STATU- OTH- <br />TORY LIMITS ER <br />EMPLOYERS' LIABILITY YIN <br />Workers Compensation (NEC <br />E.L. EACH ACCIDENT <br />S1,000,000 <br />ANY PROPRIETOR / PARTNER / EXECUTIVE <br />OFFICER /MEMBER EXCLUDED? � <br />N I A <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />I Mandatory in NH) <br />USCRIPTIION OFOrPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$1,000, 000 <br />B <br />E &O- ProfLiabPri <br />GL2000022 <br />04/01/2011 <br />04/01/2012 <br />Per Claim /Agg <br />$2,000,000 <br />Deductible <br />$100,000 <br />t <br />( ; i lsiw,: <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sch , i more spaceis required) <br />THE CITY OF SANTA ANA ARE NAMED INSURED AS PER ATTACHED FORM. <br />L 1'L) <br />CERTIFICATE HOLDER 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 />ATTN: CARL MAREK <br />20 CIVIC CENTER PLAZA I�• /l <br />P.o. BOx 1988 <br />M -77 <br />SANTA ANA CA 92701 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 />c <br />m <br />E <br />m <br />O <br />S <br />°o <br />0 <br />0 <br />V <br />°o <br />O <br />Z <br />O) <br />R <br />w <br />t <br />d <br />U <br />