OP ID: 9Z
<br />14� °REX CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/YYYY)
<br />05124/11
<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 734- 741 -0044
<br />Hylant Group Inc - Ann Arbor 734- 741 -1850
<br />24 Frank Lloyd Wright Dr J4100
<br />Ann Arbor, MI 48105
<br />JPaul Dixon
<br />CONTACT
<br />NAME:
<br />PHONE 'FAX No
<br />Alc Ext
<br />IL
<br />ADDRESS:
<br />PRODUCER FAACI -1
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED FAAC, Inc.; IES Interactive
<br />INSURER A: Travelers Indemnity Company
<br />025658_ _
<br />INSURER B:
<br />$ 1,000,000
<br />Training, a division of FAAC;
<br />INSURER c
<br />Realtime Technologies, Inc.
<br />1229 Oak Valley Drive
<br />Ann Arbor, MI 48108
<br />Santa Ana, CA 927
<br />INSURER D:
<br />05/01/11
<br />INSURER E
<br />—0—AM—AGE—TO-RENTED
<br />PREMISES Ea occurrence
<br />INSURER F:
<br />MED EXP (Any one person)
<br />$ 10,000
<br />.,.—A - 0 r=oTlclrerc nll Mr -tER: 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.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />UBR
<br />POLICY NUMBER
<br />MMIDDfYYYY
<br />MM /DDIIYYYY
<br />LIMITS
<br />FOjRM
<br />GENERAL LIABILITY
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />•
<br />X COMMERCIAL GENERAL LIABILITY
<br />X
<br />Santa Ana, CA 927
<br />6309237P921
<br />05/01/11
<br />05/01/12
<br />—0—AM—AGE—TO-RENTED
<br />PREMISES Ea occurrence
<br />$ 300,00
<br />MED EXP (Any one person)
<br />$ 10,000
<br />CLAIMS -MADE I •• 'OCCUR
<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 />$ 2,000,000
<br />$
<br />POLICY PRO LOC i
<br />•
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />BA9237P921
<br />05/01/11
<br />05/01/12
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />-.
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />$
<br />NON - OWNEDAUTOS
<br />_
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />-- —
<br />A
<br />EXCESS LIAB JX
<br />CLAIMS -MADE
<br />CUP9237P921
<br />05/01/11
<br />05/01/12
<br />-
<br />- --
<br />DEDUCTIBLE
<br />$
<br />X
<br />RETENTION $ 10,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE
<br />UB9237P921
<br />05/01/11
<br />05/01/12
<br />X WC STATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 500,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 500,00
<br />OFFICER /MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />E.L. DISEASE - POLICY LIMIT
<br />_
<br />$ 500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Snata Ana, its officers, employees, agents, volunteers and
<br />representatives, is added as additional insured as respects operations of
<br />the named insured performed under contract with the City of Santa Ana for
<br />the General Liability.
<br />CERTIFICATE HOLDER CANCELLATION
<br />` my Anof71ey © 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
<br />CITSA11
<br />APPROVED
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />_ ED AS TO
<br />FOjRM
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988
<br />t
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center PI l a
<br />Santa Ana, CA 927
<br />ERESA
<br />i-
<br />L
<br />` my Anof71ey © 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
<br />
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