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11 M R Vf fVR IIWIN V,Y V VV,Y INW R Ip V <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />CERTIFICATE OF LIABILITY INSURANCE I <br />UATE(MMI°°YYYY) <br />L 5/30/2012 <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 ar$,AQDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certalm'pollcjes-r7ay 1'equIf3 ah &dorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER _ <br />CONTACT CSU Unit <br />Commercial Lines - 415 541-7900 I' <br />( ) '. <br />PHONE FAX <br />415-541-7900 866-495-4735 <br />AJC. N9. Eat): , (NC Not -. <br />Wells <br />Wells Fargo Insurance Services USA, Inc. - CA Lic#: 0008408 <br />E-MAIL Cllfi <br />l i <br />sanrancsco.cers a'wesar o.com <br />EACH OCCURRENCE _ _ <br />- - _ <br />ADDRESS: g <br />45 Fremont Street, Suite 800 <br />INSURERS) AFFORDING COVERAGE _ _ NAIC 0 <br />San Francisco, CA 94105-2259 <br />INSURERA Great Northern Insurance Company 20303 <br />_ _ <br />INSUREDO III �} <br />INSURERS Federal Insurance Company. i 20281 <br />Orrick, Herrington 8 SuldiBe, LLP -2 1 <br />YYY <br />INSURER L <br />405 Howard Street <br />_ <br />INSURER D: <br />INSURER E <br />San Francisco, CA 94105 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMRER- 438ti3/1 RFVISION NIIMRFR, coo h.1— <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INTRR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER _� MMIDCIYYVY MMIDD YYYY LIMITS <br />A <br />GENERAL LIABILITY <br />35821151 <br />06/01/2012 <br />OFi/01/2013 <br />EACH OCCURRENCE _ _ <br />- - _ <br />$ 1,000,000 <br />- -- - <br />X <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES <br />PREMISES (E ccurrence). _. <br />$ 1,000,000 <br />J CLAIMS -MADE X_1 OCCUR <br />MED EXP (Any one person) _ <br />$ _ _ 10,000 <br />PERSONAL B ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />S 2000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ incl in can A99 <br />I PRO-JECT <br />_ <br />X POLICY LOC <br />$ <br />BOMOBILE <br />AUT LIABILITY <br />74996569 <br />06/01/2012 <br />06/01/2013 <br />GOMBINLD SINGLE LIMIT <br />1 000,000 <br />(En edr,donS -- _ -- <br />-$ _. <br />�ANV AUTO <br />' <br />BODILY INJURY (Per person) <br />S <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />I <br />- <br />BODILY INJURY (Per accident)I$ <br />% I % <br />�I <br />'iI <br />PROPERTY DAMAGE <br />$ <br />1- I HIRED AUTOS AUTOS <br />(Per acaEen9 <br />I <br />$ <br />B <br />UMBRELLA <br />UMBRELLA LIAB % OCCUR <br />__ <br />79820023 <br />06/01/20121 <br />06/01/2013 <br />EACH OCCURRENCE <br />g 5000,000 <br />EXCESLIAR CLAIMS MADE' <br />AGGREGATE <br />S 5000,000 <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />Ns <br />F 1 <br />WC <br />AND EMPLOYERS'LABILIITY <br />APPR(}L <br />... <br />TORY LIMITS ER <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />❑YIN <br />NIA <br />- -- <br />(MandaOFFICEtory InN )EXCLUDED? <br />(ManOatory In NH) <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />If yes, describe under <br />-- <br />-- <br />- <br />DESCRIPTIONOFOPERATIONS below <br />_ <br />E. L.. DISEASEPOLICYLIMIT <br />$ <br />Lau" Stitt- <br />City <br />ASS1SLal" <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space is required) <br />The City, its officers, agents, volunteers and employees are named as Additional Insured as their interest may appears <br />CFRTIFICATF HOI DFR CANCFI I ATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 CIVIC Center Plaza M17/PO Box 1988 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />cause <br />The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) 11 11 11 111 11 111 11 1111111111111 <br />creosAaoroolssvozraxmmmro <br />