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OR685544 <br />®� CERTIFICATE OF LIABILITY INSURANCE <br />FDAT5/31/DD/YYYY) <br />5/31/2013 <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 policy(ies) 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 endorsement(s). <br />PRODUCER <br />Commercial Lines - (415) 541-7900 <br />Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 <br />CONTACT CSU Unit <br />NAME: <br />_ <br />PHONEo Exit, 415-541-7900 Hole Not: 866-495-4735 <br />_ <br />EMAIL .comt <br />sanrancsco.cers wellsfar o <br />f i <br />ADDRESS: @ 9 <br />_ <br />INSURERS) AFFORDING COVERAGE <br />NAIC # <br />45 Fremont Street, Suite 800 <br />INSURERA: Great Northern Insurance Company <br />20303 <br />San Francisco, CA 94105-2259 <br />INSURED <br />Orrick, Herrington & Sutcliffe, LLP <br />INSURER e: Federal Insurance Company <br />20281 <br />INSURERC: <br />405 Howard Street <br />INSURER D <br />CLAIMS -MADE � OCCUR <br />INSURER E: <br />San Francisco, CA 94105 <br />INSURER F: <br />MED EXP (Any one person) <br />COVERAGES CERTIFICATE NUMBER: 6126300 REVISION NUMBER: See below <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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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 PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />Ii <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DO/YYYY <br />POLICY EXP <br />MWDD/YYYV <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />35821151 <br />06/01/2013 <br />06/01/2014EACHOCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RE TED <br />PREMISES (Ea occurrence) <br />$ 1,000,000 <br />_ <br />CLAIMS -MADE � OCCUR <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGO <br />$ Incl In Gen Aug <br />PRO LOC <br />X POLICY JECT <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />74996569 <br />06/01/2013 <br />06/01/2014 <br />COMBINED SINGLE LIMIT <br />Ea accident)_,__ <br />1,000,000 <br />_.$ <br />BOO I LY I NJU RY(Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SC <br />AUTOS AUTOS PEDDLED <br />BODILY INJURY ( Per accident) <br />$ <br />X <br />NON -OWNED <br />HIREDAUTOS X AUTOS <br />ROPERTY DAM <br />PAGE <br />Peraxidom) <br />_ <br />$ <br />B <br />X <br />UMBRELLA LIAB <br />I X <br />I OCCUR <br />79820023 <br />06/01/2013 <br />06/01/2014 <br />EACHOCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />$ 5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATIONWC <br />STATU- OTH- <br />ANDEMPLOVERS'LIABILITY Y/N <br />ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ <br />OFFICEWMEMBER EXCLUDED? <br />N / A <br />T V E <br />E.L. EACH ACCIDENT <br />._ <br />$ <br />— <br />E.L. DISEASE - EA EMPLOYEE <br />----- <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />'--- <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) <br />16-02-0292 (Ed. 9-10),80-02-9090 (Rev. 6-05),80-02-2000 (Rev. 4-01) The City, its officers, agents, volunteers and employees are named as Additional <br />Insured as their interest may appear. <br />APPROVED AS TO }'caRN <br />C <br />-94: <br />E. oR K <br />ISA / <br />Assistant City Attorney <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, Finance and Management Services Agency <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza M17/PO Box 1988 <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />Cj74nw��� <br />The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (20160/05) 1111111111111111111111111111111 111 1EI 11111111111 1111� 111111111111 <br />•cveo4eoar000loolavlzmlololo• <br />