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CERTIFICATE OF LIABILITY INSURANCE DATE (MN1//2011 <br />2 „ <br />PRODUCER Wood Gutmann & Bogart Insurance Brokers <br />15901 Red Hill Ave., Suite 100 <br />Tustin, CA 92780 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />LicenseNo. 0679263 714 505.7000 <br />www.w bib.com 714 573.1770 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Coast Live Oak School <br />INSURER A: Philadelphia Insurance <br />11651 Plantero Dr <br />Santa Ana CA 92705 <br />INSURER B: <br />INSURER C: <br />NSUZR D: <br />9/22/2012 <br />SURER E: <br />1825 W. Civic Center Drive <br />Santa Ana CA 92701 <br />COV <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, 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 PAID CLAIMS. <br />INSR <br />OD' <br />INSRO <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />LIMITS <br />EACH OCCURRENCE $ 1000000 <br />A <br />and Community Services Agency <br />GENERAL LIABILITY <br />PHPK771929 <br />9/22/2011 <br />9/22/2012 <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />1825 W. Civic Center Drive <br />Santa Ana CA 92701 <br />COMMERCIAL GENERAL LIABILITY <br />- <br />AUTHOR -ED REPRESENTATIVE <br />DAMA E T NT D <br />PREMISES Ea occurrence $ 100000 <br />MED EXP (Any one person) $ 5000 <br />Jeff Sachs / • y/'�� <br />CLAIMS MADE 171 OCCUR <br />PERSONAL 8 ADV INJURY $ 1000000 <br />GENERAL AGGREGATE S 2000000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />_ <br />PRODUCTS - COMP/OP AGG $ 2000000 <br />POLICY PROJECT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT S <br />(Ea accitlent) <br />BODILY INJURY S <br />(Per person) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(Per accitlan[) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accid—) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />ANY AUTO <br />AUTO ONLY: AGG $ <br />EXCESS / UMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />OCCUR CLAIMS MADE <br />FORM <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />'- "" <br />._ -' L ? :-. tit (� <br />`, , <br />`e --- <br />WC STATU- OTH- <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />[ y V <br />. <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />(Manda[ory In NH) <br />If yes, tlescri be under <br />— <br />E.L. DISEASE -POLICY LIMIT $ <br />SPECIAL PROVISIONS below <br />OTHER <br />A <br />Abuse Sublimit <br />PHPK627827 <br />9/22/2011 <br />9/22/2012 <br />Per Person $100,000 <br />Aggregate Limit $300,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />The City of Santa Ana , it's officers, agents and employees are hereby added as Additional Insured as per form CG2026 „ 85 attached. <br />Insurance provided is Primary and Non -Contributory. <br />4,.CR I IrlliA 1 C 1'IVLUCR <br />GANGtLLA I IVN ' <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Santa Ana; Parks, Recreation <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN <br />and Community Services Agency <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Attn: Carmen Acosta <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />1825 W. Civic Center Drive <br />Santa Ana CA 92701 <br />REPRESENTATIVES. ' 10 Day. Tor Non -Payment of Premium. <br />AUTHOR -ED REPRESENTATIVE <br />Jeff Sachs / • y/'�� <br />ACUKU 25 (2UU9/U1) © 1988-2009 ACORD CORPORATION. All rights reserved. <br />CERT NO.: 11351')62 CLIENT' CODE: CORS Robin Rollovay 10/10/2011 2:43:52 PM Page 1 O£ 3 <br />