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lc <br />DATE(MIWDDIYYYYj:.. <br />A.. D' CERTIFICATE OF LIABILITY.- INSURANCE julys,zo„ <br />THIS. CERTIFICATE 1S ISSUED AS A MATTER. OF- INFORMATION ONLY AND'.. CpNFEftS NQ RIGHTS UPON. THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES. NOT AFFIRMA11VELY OR NEGATIVELY AMEND., EXTETlD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />` BELOW. THIS CERTIFICATE O DOES NOT CONSTITUTE A CONTRACT BETWEEN, THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTA7nVE OR PRODUCER, AND THE CERTIFICATE HOLDER.- <br />` <br />IMPORTANT: If the certificate holder i's an ADRITtONAL INSIJREF,, the ;policy {ies) must be endorsed. 1# SUBROGATiQN IS WAIVED, subject to <br />the terms and conditions of the policy, ceCEain policies may require an endorsemeint. A statement on This certificate does not confer rights to the <br />certificate holder in lieu of sukh endorsement(s). <br />coNTacr Mike MCC; <br />py <br />PRODUCER NAME: <br />P K'nsu' n Ce PHONE 866-679--0802 .. FAx 866-559-3091. <br />120E3 E. Glen Avenue Mnii me r�o <br />Peoria He"Ighft, IL 61675 ,anors�ss: M ike M cCo. ^. Pe arllnsurance.com - <br />moo.r_= uarr i� <br />. <br />INA{ll't pqJJ NP PV RLtlTu MV v �viaaa:' •• ^•� •• <br />INSURER: A Va: ll ey Forge Insurance Company 20508 <br />INSURED <br />inisufMR e : Continental Casualt y Company. 20443 <br />Albert GroV'e1& Associatesj. Inc. <br />i�usu�R C c American Cos. Co. of heading PA 20427 <br />2 Hvwy, Smite 208 <br />iNSUREkD: _ <br />F Lid I ertdn" CA 92835 -7047 <br />INSURER E : .. <br />' <br />INSURER F : .. <br />COVER-AGES CERTIFICATE NUMBE17: REVISION !NUMBER: <br />THIS- IS TO CEFtT[FY THAT THE POLICIES OF,%-1NSURANCE'.L1S'l�D. i3EL0-W'-HAVEBEE-N ISSiJED TO.'THE INSURED NAMED ABODE FOR- THE POLICY-PERIOD <br />TO. ENRICH TH. lS <br />INDICATED; N0jWTHST%AND1NG ANY'REQUIREMENT%i T.E.RM dR CONDITION OF- ANY CONTRACT Oii. OTHER DOCUMENT WT--H RESPECT... <br />CERTIFICATE NfAY BE ISSUED Ofi fiA+4Y PEFt7Pi]N, <br />THE INSURANCE AFFORDED'BY THE. POLICIES DESCRESED HEREfN 1S SUBJECT TO. L THE TERMS;, 11 <br />EXCLUSIQNS AN D CON �iTIQNS OF S UCH PdLICEES. LlMll'S SH011UN MAY HAVE B EEN RED UCED:BY'PAI D C LAIIUIS <br />... <br />.. .. ADDL SUBR � - : .:.... POLICY EFF i�OLICY EXP. : ..:.. <br />INR TYPE OF INSURANCE POLICY NUMBER M LIMITS. <br />GENERAL LIABILITY <br />A X X,. <br />EACH QCCURRENCE $ 7 �00Or000 <br />� <br />4030800732 07701111 0710111.2 DAMAGE R�n�TEO 1:70004100 <br />COMMEF2CIAL GENEftAI. UABILIT'f <br />PREMISES E� ocuirrent;e . <br />CLAIMS- M,4[�E OCCUR <br />MEQ EXP ZArry one person} <br />X Pn,mar/I�IOEI C011t17I�L�r]/ <br />PERSONAL 8 ADV INJl3RY ; $ 1,000,000 ` <br />GE NE Ai3GRECaATE .. $ 210001000 <br />GEN 'LAGGRECaA7ELIMITAPPI.tESPE}2: <br />ARODUCTS- CON9P /OPi1GG. $. 20000,000 <br />... -... X POLICY PRO -. LO <br />3'� .. .. <br />.... ... <br />... .. .� .. <br />a��M�3l�EGLE LIMIT $ � 3000 �fl00 <br />AUTOMOBILE LfABILI'X <br />/# <br />Ea <br />07101111 0710111.2 <br />4030800732 BODILY INJURY- (Perperson) $ <br />ANY';SUIO. <br />_ <br />I IICILddd'i fl. CsL p'lipy gpDICY tNJl1RY (Per accident). <br />AUTOS AUTOSULE� <br />NoN- ownr�o, <br />Hi're­­'d'--A'd'to':Ph.sical Damage PROPERTY DAMAGE $ <br />X X. <br />..H X p,�Tp$. <br />DLdUCtlble:, $Y�JO PeraocideM <br />X iIMBRELLA LIAB. X p�CUR <br />0701--j-11 I 07iO'II'12. EgCH OCCURRENCE $ ��OOQ�O00 <br />4030801783-' <br />B <br />EXCESS LIAB CLAIMS =MADE <br />�GIYd�S PrbfassiO[18I � A:GGREGATE '.. $.��aOOYOOO . <br />�., <br />W01bility.... <br />$ <br />�E� RETENTION $ . .. <br />`. WORKERS COMPENSATION <br />j( 1NC STATU- . OT-H-1 <br />4$OSOOTBO ... OT /Q7I17 T Y I <br />AND EMPLOI(ERS' LIABILITY-YIN <br />ANY FROPRIEfDRJPARTNERIEXECUTIVE <br />1 X <br />B18f1IC @t W81VSf of Su bf0y8tlOf1. E.L. FAGt9 ACCIDENT .. S � 7000V000 <br />� � <br />OFF ICERlMEMBER EXCLUDE? y N A <br />(MandatorV-.in- <br />Endt WCO00313 �� � � 1 )00 OOD <br />E.L. DISEASE - EA'EMPLOYE <br />f yes, describe under <br />DESCRIPTION dF OPERATIONS below <br />E.L: DISEASE - POLICY'L3N11T $�1O0O1diiO <br />B P*dftssional Liabiiify <br />M1CA2$835A455 07/01(11 07101112'. $2.00 O,a00 each claim <br />Claims Made <br />$4,000,000 aggregate <br />A-P V ED <br />DESCRIPTION OF OPERATIPNS /LOCATIONS !VEHICLES (Attach ACOI2D iM, Additional Remarks Schedule, if morieapaoe is requiredj <br />c1\4111Transportaftor.dTraffic Engineering Firm <br />''t��� She aY <br />RE: 2 01 Citywi d e Engineering and Traffi c Survey <br />Assistant Czty Attorney <br />Exd ud ed offcerAlbert. Grover from the above Workers'Compensa6or� Po I I Cy <br />CERTIFICATE HOLDER <br />CANCELLATION......- <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE. Ci4AECEl.1.ED BEFORE <br />City of Santa Ana <br />THE EXPIRATION ATE . THE REOF, N07r10E WILL BE DELIVERED IN <br />20 CiVic Center P1 a, M-43 <br />ACCORDANCE WITH'THE POLICY PROVISlO[�lS. <br />Santa Ana CA 52701 <br />i' <br />AUTHORIZED REPRESEidT/[TIVE <br />O 1988 -2010 A CO RD CO RPORATION. A[! righis reserved. <br />ACORD 25 (2010105) The ACORD name and Togo are registered marks of ACORD <br />