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CERTIFICATE OF LIABILITY INSURANCE OPID SG DATE(MWDWYWY) <br />DESMO-1 11 30 10 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />LTR <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />JOHN T- MATSOCFC 6 ASSOC. INC_ <br />1750 N WAINGTON ST <br />SH \ <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />DATE M W <br />NAPERVII.LE IL 60563 <br />Phone .' 630-505-7888 /� I —O <br />INSURERS AFFORDING COVERAGE MAIC B <br />INSURED <br />INSURER Hartford I-0-=aInC@ Co njr 00914 <br />INSURER & <br />INSURER C: <br />Donna D@smondA8yy80(GC�1at.@S <br />INSURER D: <br />x.06 Ang@ iao CA 9D024@n BIVd_ <br />INSURER E <br />83SBAVZ5827 <br />THE POLICIES CF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICATED. NOTWITHSTANDING <br />ANYREQUIREMENT• TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PMD CLAIMS. <br />LTR <br />NSR <br />TYPE OF MSURANCE <br />POLICY NUMBER <br />DATE M W <br />DATE M <br />LIMITS <br />RWRESEaIrnrnlM. <br />AVTHO REPRESENTATIVE <br />GENERAL LIABILITY <br />EACH OCCURRENCE 51,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE O OCCUR <br />83SBAVZ5827 <br />12/01/10 <br />12/01/11 <br />$300,000 <br />ME <br />1O 000X <br />PERSONAL 6 ADV INJURY 31 OOO 000 <br />GENERAL AGGREGATE S 2 , 000 , 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/CP AGG i2 OOO OOO <br />X POLICY jECOT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea ar ,M) S 1000 OOO <br />BODILY INJURY <br />(pw P_n) S <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />A <br />A <br />X <br />X <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />83SBAVZ5827 <br />83S33AVZ5827 <br />12/01/10 <br />12/01/10 <br />12/01/11 <br />12/01/11 <br />BODILY INJURY <br />(Pa eC1 _> s <br />PROPERTY DAMAGE i <br />(PH —W—) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT i <br />OTHER THAN EA ACC S <br />ANY AUTO <br />Fl <br />AUTO ONLY' AGG E <br />EXCESS I UMBRELLA LIABILITY <br />EACH OCCURRENCE S <br />OCCUR CLAIMS MADE <br />qpP RU v IiJ <br />AGGREGATE i <br />i <br />i <br />DEDUCTIBLE <br />RETENTX)N <br />K MPFIJBATION <br />AND EMPLOYERS• LIABILITY YI1 <br />ANYPROPRIETOR/PARTNER _ IV <br />XECUTfLJ <br />OFFICERIMEMBER EXCLUDED? <br />ASSISI <br />"- <br />Ill ... <br />TORY LIMIT6 ER <br />E.L. EACH ACCIDENT i <br />E.L. DISEASE - EA EMPLOYE i <br />(Manaalory .n NH) <br />r yea. a <br />SPECIALPROVISIONS pBlw <br />E L DISEASE -POLICY LIMIT S <br />OTHER <br />A <br />Property S@Ction <br />83SBAVZ5827 <br />12/01/30 <br />12/01/11 <br />$500 DED $5,000 <br />DESORPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDBD BY ENODRSEMENT /SPECIAL PROVISIONS <br />ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY: CITY OF SANTA ANNA, <br />ITS OFFICERS, EMPLOYEES, AGENTS, VOLUTEERS AND REPRESENTATIVES//AS REQUIRED <br />BY WRITTEN CONTRACT, CERTIFICAMMS ARE St7B.7ECT TO ALL POLICY TERMS AND <br />CONDITIONS . <br />CERTIFICATE HOLDER CANCELLATION <br />Z& (zoDB/DT) , --qwrTqvS-EOOIrACORD CORPORATIOpI_ All rights reserved_ <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />SANTAAN <br />DATE THEREOF, THE ISSUING INSURER VOLL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br />CITY OF SANTA ANNA <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL <br />PUBLIC WORKS AGENCY <br />IMPOSE NO OBLIGATION OR LIABILITY OF AMY RVND UPON THE INSURER ITS AGENTS OR <br />ATTR : !CENT JORGENSEN <br />20 CIVIC CST7TER PLAZA M-36 <br />RWRESEaIrnrnlM. <br />AVTHO REPRESENTATIVE <br />SANTA ANNA CA 92701 <br />Z& (zoDB/DT) , --qwrTqvS-EOOIrACORD CORPORATIOpI_ All rights reserved_ <br />The ACORD name and logo are registered marks of ACORD <br />