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a? ?_ Q® <br />`vv'A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YVYV7 <br />os-19-2012 <br />THIS CERTI FICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRM ATIVELY 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 INSURERIS), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONALINSURED, the policylies) must be endorsed. If SUBROGATIONIS 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 />WIAA INSURANCE SERVICES/PHS PHONE <br />(877)905 <br />0457 <br /> - <br />"/c Np Ext: (666)467-&730 cA/c, Npl: <br />251467 P- (866)467-8730 F• (877)905-0457 <br /> ADDRESS: <br />PO BOX 3 3 O 15 <br />? <br />SAN ANTONIO TX 7 8 2 6 5 {?\ cusTOMER ID r: <br />? ? \ <br />V INSU RER(51 AFFORDING COVERAGE NAIC M <br />INSVRED INSURER A Hartford Ca SLlalt IRS CO ? <br /> INSURER B : Hartford Underwriters Ins co <br />WHITE NELSON DIEHL EVANS LLP <br /> INSVRER C: <br />2875 MICHELLE STE 300 <br />IRVINE CA 9 2 6 0 6 INSURER D <br /> <br /> INSURER E <br /> INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAV 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTq ? TYPE OF INSURANCE IIVSq ? WVU PO LICV NUMBER IMM/DDN VYYI IMM/DDN YY YI LIMITS <br />GENERAL LIABILITY EACH OCCURRENCE ? 5 1, 0 0 0/ O O O <br />?I 3 O O <br />0 0 0 <br />IABI LITV <br />COMMERCIAL GENER <br />A <br />L L , <br />PREMISES IEe o ca) 5 <br />t <br />? <br />? <br />? <br />i?l CLAIMS-MADE l i? l OCCUR MED EXP (Any one <br />personl ? 5 1 O, O O O <br />A <br />X? General Liab 72 .SBA K7a9101 01/01/2012 01/01/2013 PERSONAL&ADV INJURY 5 ?-, OOO, OOO <br /> GENERAL AGGREGATE 5 2, O O O, O O O <br />?N'L AGGREGATE LIMIT A <br />PP <br />I E <br />S PER: <br />L PRODUCTS -COMP,/OP AGG 5 2 , O O O , O O O <br />? <br />? <br />/ <br />I <br />I I POLICY ? jROT I ?° I LOC S <br />? AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT I <br />s <br /> IEe occident) <br />1, 0 0 0, 0 0 0 <br /> ANV AUTO BODILY INJURY (Per person) 5 <br /> ALL OWNED AUTOS i BODILY INJURY IPer eccidenH' S <br /> <br />A SCHEDULED AUTOS <br />72 SBA KZ 9101 <br />01/01/2012 <br />01/01/2013 <br />PROPERTY DAMAGE 15 <br />X HIRED AUTOS (Pcr nccidcnJ <br />I, X NON-OWNED AUTOS <br />5 <br /> <br />? S <br />? X VMBRELLA LIAB I ?. OCCUR <br />? ?• I EACH OCC VRRENCE 5 4, 0 0 0, O O O <br /> EXCESS LIAB <br />CLAIMS-MADE AGGREGATE ? S 4, 0 0 0, O O O <br />A I <br />I DEDUCTIBLE 72 SBA KZ 9101 of/oi/zoiz of/oi/zoi3 s <br />X RETENTION 5 1 0 O O O ? 5 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY I X I TORY IMITS ??OER <br />Y / N GOO <br />G O U <br />AN': PROPRIETOR/PARTNER/EXECUTI VEII <br />' <br />? N/A 1 , <br />E.L. EACH ACCIDENT 5 1 , <br />(ManAntoryEMBER EXCLUDED? u <br />B 72 WEC 1X3258 06/01/2012 06/01/2013 E.L. DISEASE - EA EMPLOYEE; 5 1 r OOO r OOO <br />DESCRIPTION OFdOPERAT10N5 below E.L. DISEASE -POLICY LIMIT 5 1 r 0 0 0 r O O O <br /> <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES IAtteoh ACORD t01. Addltfonel Remerka Schedule, i( more space ie required) <br />Those usual to the Insured's Operations, <br />CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />City of Santa Ana BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />Clerk of the Cit <br />Council DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />y <br />20 CIVIC CENTER PLZ # M30 <br />SANTA ANA <br />CA 9 2 7 O 1 AUTHORIZE PRESENTATIVE?j <br />?'Z <br />/ ???'?? <br />, -- <br />? 7988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD