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A� o® CERTIFICATE OF LIABILITY INSURANCE <br />°A0421/20114YY) <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 pollcy(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 endoreement(s). <br />PRODUCER <br />Pro-Form Sinclair Professional <br />675 Cochrane Drive <br />NAME: Dafng Warshager <br />- -- <br />PHONE a 1 905- 305 -1054 FAX N�O5�06 -1093 <br />No. <br />E+4AIL <br />ADDRESS: define .warshager @hubinterna[ional.com <br />Suite 200, East Tower <br />Markham, ON OR 058 <br />U5000085371-114A <br />04/30/2014 <br />04/30/2015 <br />INSURERS AFFORDINGCOVERAGE <br />NAICS <br />_ <br />INSURER A:XL Insurance America, Inc. _ <br />24554 <br />INSURED <br />IBI Group <br />INSURER B:XL Specialty Insurance Company <br />37865 <br />18401 Von Kerman Avenue, Suite 110 <br />INSURER C: <br />S 5,000 <br />INSURER D: <br />CLAIMS -MADE 7 OCCUR <br />Irving, CA 92612 <br />INSURER E: <br />1s t I I I of <br />-A4J _f U7 <br />INSURER F: <br />PERSONAL &AW INJURY <br />COVERAGES CERTIFICATE NUMBER:PLGANRT3 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />INTSIR TYPE OF INSURANCE <br />L <br />POLICY NUMBER <br />POLICY OFF <br />MINA YY <br />POLICY EXP <br />MMID <br />LIMITS <br />A <br />GENERAL UAWLITY <br />U5000085371-114A <br />04/30/2014 <br />04/30/2015 <br />EACH OCCURRENCE <br />s 1,000,000 <br />PREMISES Eacccurmnce <br />S 300,000 <br />%( COMMERCIALGENERALLIABILITY <br />MEO EXP (Any one person) <br />S 5,000 <br />CLAIMS -MADE 7 OCCUR <br />PERSONAL &AW INJURY <br />$ 1,000,000 <br />X Contractual Liability <br />GENERAL AGGREGATE _ <br />S 1,000,000 <br />GENIE AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP /OP AGE <br />S 1,000,000 <br />$ _ <br />X POLICY PRO- LOC <br />B <br />AUTOMOBILE UABIUTY <br />MAGO03760402 <br />Deductible: $2,000 Camp. / $2,000 <br />04130/2014 <br />04/30/2015 <br />Ea acdtlenlSINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X ANY AUTO <br />Collision <br />BODILY INJURY (Par accident) <br />$ <br />ALL OWNED 50HEDULEO <br />ADTOS <br />X HIRED AUTOS X AUTOS <br />R <br />TO <br />M <br />PROPERTY <br />$ <br />$ <br />X E2,000 Comp./ <br />$12,000 Collision <br />UMBRELLA UM <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE $ <br />E XCESS LIAB <br />CLIU"_MADE1 <br />C <br />7 <br />DED RETENTION $ <br />1 <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERVLIABILITY YIN! <br />ANY PROPRIETOR,PARTNERIE%ECUTIVE <br />em� <br />IeNrar aad <br />C STATU- OTH- <br />T W RY R <br />I <br />E.L. EACH ACCIDENT <br />_ <br />S <br />E. L. DISEASE EA EMPLOYEE <br />$ <br />OFFICEMMEMBER EXCLUDED? ❑,NIA <br />(Mandatory In NH) <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />If yyeess describe under <br />DESCRIPTION OF OPERATIONS beiov <br />B Professional Liability Insurance <br />DPR 9714334 <br />04130/2014 04/30/2015 <br />Each Claim <br />Annual Aggregate <br />1,000,000 <br />$ 1,000,000 <br />$ <br />$ <br />$ <br />DESCM"T OFOPERATIONSILOCATIONSIVEHICLES (Attach ACORD 101, Additional Remarks Schsduls, Broom 11. required) <br />IBI Project 30866 Santa Ana General Plan Circulation Element Update <br />'City of Santa Ana, its officers, employees, agents, volunteers and representatives" are added as additional insured to Commercial General Liability, Automobile Liability <br />and/or Umbrella Liability only, but only with respect to liability arising out of the operations of the named Insured. <br />The Insurer will provide the Certificate Holder with thirty (30) days written notice of cancellation of the policy. <br />Limits shown are in US Dollars. <br />CERTIFICATE HOLDER CANCELLATION <br />Page l at 1 v 19aa -206 ACORD CORFORAT IVrv. All ngnis <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />20 CIVIC Center Place, M -20 <br />P.O. Box 1988 <br />AUTHORISED REPRESENTATIVE <br />Santa Ana, CA 92702 -1988 <br />Page l at 1 v 19aa -206 ACORD CORFORAT IVrv. All ngnis <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />