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�� <br />/�.. <br />'``c °R° CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM1ODlYVYY) <br />�� <br />9/17/2012 <br />THIS CERTFICATE 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: ]f the cartifl cafe "holder Is an ADDITIONAL INSURED, the pollcy(las) must ba endorsatl. If SU.BROGATON.I S..WAIVED,- subJect to. <br />the terms and canditlons of the policy, certain pollclas may raqulra an endorsement.- A statement. on -, this certlflcata does notconfer rights to the <br />` certlflca[e holder in Iteu of such endorsement s -. - - <br />.. ., •. <br />PR000CC-R _. <br />- Er1Ca HOrnaday _ .... -. _. <br />'. <br />The E�11p1=A.. Canlpatiy � __. . . __.. _ .- .... _. _ .... . - _. <br />PHONE _ � "(714)` 836 -9945: .. . <br />. AfC Nor (314)&36 -9946 _.. <br />550 Par)ccenter Drive - <br />I � - .- ®hornaday @empires -oo .com � - -- - -- - - -� � -�- - �-� <br />Spite ZO S - � <br />Santa Ana CA 92 7 0 5 -352 1 <br />INSURERS AFFORDING COVERAGE <br />� NAIG i. " <br />INSURERA:GO1dcn Ea 1a Snsurance C n <br />0836 <br />INSUR> =o <br />TE22iid3 PORTAT20N STLTD2 ESr 2NC. <br />INSURERB:HartPOrd 2naurancc C an oY� <br />S 1 , 000 , 000 <br />INSURERC:Uni tell. States Liabillt <br />5895 <br />2640 WAL27LTT AVLP STE H <br />INSURERD: <br />- <br />Un1t H <br />INSURER E <br />P EMI <br />TUSTYN CA 927$0 <br />INSURERF: <br />X CLAIMSMAOE � OCCUR <br />THIS lS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW'HAVE BEEN ISSUED SO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WFi ICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED'HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIq CLAIMS. <br />IL SR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />P LICY EFF - <br />POLL EXP <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURR ENGE <br />S 1 , 000 , 000 <br />X COMMERCL4L GENERAL L WBIL ITV <br />P EMI <br />$ 50 , 000 <br />A <br />X CLAIMSMAOE � OCCUR <br />OP7609482 <br />0/1/2012 <br />0/1 /2013 <br />MED EXP (Any one parse n) <br />$ 5 , 000 <br />PERSONAL BADV IN.AIRV <br />E 1,000,000 <br />GENERAL AGGREGATE <br />$ 2 , 000 , 000 <br />' <br />GEN'L AGGREGATE <br />LWIIT APALIES PER: <br />�:pRODUCiS- COMP /OP AGG <br />i 2 , 000 , 000 <br />- � <br />.. <br />- .. <br />- ._ .._ <br />X. POLICY -.. <br />.PRO- LOC <br />.. <br />� "- <br />.. <br />� � <br />.. <br />_.... <br />$ <br />All"rOMOBILE <br />LIABILnY <br />- -' <br />-,- <br />"; <br />"' -� ='� <br />Ea am nl <br />"" <br />1 000 000 <br />A <br />R. <br />-.. ,. <br />'ANY AUTO" .� <br />� <br />.,, ... <br />- _ � <br />. - �. - ._. -.. .- - <br />.. _, ... .. <br />... _. ... <br />.. _ <br />BODILY WJURV (Per Person) <br />_ . .. _. .... . <br />i �. <br />.eLL OWTJEO - .SCI- IEDULED <br />PUTOS AUTOS <br />- <br />- <br />7297043 � � <br />- <br />O/1 /2012 <br />0/1/2013- <br />- <br />BODILY N,IURY (Per eiYiC ®iY) <br />"i - <br />HIREDP1JT05 AUTOSm1ED <br />. <br />� -� _ -�' <br />- <br />� � <br />� P Aa <br />� _ ... <br />i <br />_. <br />X <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />i 1 , 000 , 000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />$ 1,000,000 <br />DED RETENTION <br />i <br />D8872632 <br />0/1/2012 <br />0/1/2013 <br />$ <br />yrORRERS COMPENSATION <br />X VAC STAT U- OTH- <br />AND EMPLOYERS' LUIBILITY Y/ N <br />E.L. EP.CH ACCIDENT <br />ANY PROPRIETOR /PAfiTNERIENECUTIVE <br />$ 1 000 000 <br />OFFICC-RAAEMBER EXCLUDED'! � <br />(MarWa[ory In NHj <br />N/A <br />ZwECRA7609 <br />0/1/2012 <br />0/1/2013 <br />EL DISEASE-EA EMPLOYE <br />$ 1 000 000 <br />11 aa. tlescribe under <br />E.L. DISEASE - POLICY LIMIT <br />$ 1 000 000 <br />DESCRIPTION OF OPERATIONS below <br />C <br />Errors 6 Omissions <br />P2022743A <br />O/1 /2022 <br />0/1/2013 <br />Lima 1,000,000 <br />DeaurS:Wa 1 , 000 <br />DESCRIPTON OF OPERATIONS / LOCATIONS /VEHICLES IAtb Cll ACORD 10'1, Aatll[lonal Remarks Sehelul e, Ir more apace Ia regWretl] <br />RE: On -Call traffic counting service_ Certificate Holder is additional insured as respects to general <br />liability per form 44 -148 (06/04) attached. primary and non - contributory wording applies £or general <br />liability par form 44 -231 (07/10) attached. <br />...> <br />:....J <br />�� a v r <br />City oP Santa Ana "°`r'-a 'Litt Jheady <br />Attn: Shahir Gobraa 'd`SSisiant City Attorney <br />20 Civic Center Plaza, M -43 <br />Santa Ana, CA 92702 <br />ACORD 25 (2010/05) <br />INS025 (2oloosl of <br />>_.' <br />SHOULD AN V OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL Y61 DELNERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS; __._� <br />mao RIZED REPRESENTATIVE <br />Jones /KATHY �� <br />®1988 -2070 ACORD CORPORATION. All rig hta reserved. <br />Tha ACORD name and bgo are ragiatarad marks of ACORD <br />