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ACORD® CERTIFICATE OF LIABILITY INSURANCE <br />`� <br />DATE (MM/DD/YYYY) <br />1 11/21/2010 <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 />Ames and Gough <br />450 Northridgeno <br />Parkway <br />Y <br />Suite 102 <br />Atlanta GA 30350 <br />CONTACT JerryNO Ola <br />NAME: Y <br />PHONE (770)552-4225 ___-- (AIC. No): <br />E-MAIL <br />ola®amen ou h.com <br />ADDRESS: j Y 4 g <br />_ <br />PRODUCER .00001398 <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />Kimley-Horn and Associates, Inc. <br />P.O. Box 33068 <br />Raleigh NC 27636 <br />INSURERA:Travelers Indemnity CO. of CT 25682 <br />_ <br />INSURER B:Trave 1 era Indemnity Company 25658 <br />INSURERC:Travelers Property Casualty Co. 25674 <br />INSURER D :Phoenix Insurance Company 25623 <br />INSURER E :Lexin ton Insurance Company 19437 <br />INSUERF:Travelers Pron. Cas. Co America 125674 <br />COVERAGES CERTIFICATE NUMBER:* 10 - 11 (Kimley Jessica) REVISION NUMBER! <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 />A DL <br />SU R <br />POLICY NUMBER <br />POLICY EFF <br />M YY <br />POLICY EXP - <br />M DNYYY LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />— I <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence $ 11000,000 <br />MED EXP (Any one person) $ 10,000 <br />A <br />CLAIMS -MADE X 1 OCCUR <br />630-8193B99A-TCT-10 <br />12/1/2010 <br />12/1/2011 <br />PERSONAL & ADV INJURY $ 11000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS - COMP/OP AGG $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICYFX PRO X LOC <br />Si <br />B <br />AUTOMOBILE <br />X <br />'- <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />-810-57248497-IND-10 <br />2/1/2010 <br />2/1/2011 <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ 11000,000 <br />— — <br />BODILY INJURY (Per person) $ <br />__-_.—___..__.__- <br />BODILY INJURY (Per accident) $ <br />- <br />X <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />! <br />� <br />— -- -- <br />PROPERTY DAMAGE $ <br />(Per accident) <br />X <br />NON -OWNED AUTOS <br />Underinsured motorist BI split $ <br />Uninsured motorist property S <br />X <br />UMBRELLA LIAR X I OCCUR <br />EACH OCCURRENCE $ 5,000,000 <br />AGGREGATE $ 51000,000 <br />EXCESS LIAB CLAIMS -MADE <br />---- <br />DEDUCTIBLE <br />$ <br />j <br />C <br />' X I RETENTION $ 10,000 <br />S14-CUP-8193B99A-TIL-10 <br />12/1/2010 <br />2/1/2011 <br />$ <br />D <br />F <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. <br />OFFICER/MEMBER EXCLUDED? � <br />(Mandatory in NH) <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NUB -8193899A-10 <br />N/A <br />PNUB-8193B99A-10 (CA) <br />12/1/2010 <br />12/1/2010 <br />2/1/2011 <br />12/1/2011 <br />X WCSTATU- OTH- <br />Y <br />EACH ACCIDENT $ 500 0 <br />00 <br />E.L. DISEASE - EA EMPLOYEE $ 500,000 <br />-'-'------ <br />E.L. DISEASE - POLICY LIMIT $ 500,000 <br />E Professional Liability <br />016017332 <br />12/9/2010 <br />12/1/2011 Per Claim $2,000,000 <br />Aggregate $2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more specs In required) <br />Re: McFadden McDonalds. The City of Santa Ana, its officers, employees & volunteers are named as Additional Insureds <br />on the above referenced liability policies with the exception of workers compensation & professional liability. <br />Umbrella Follows Form. <br />City of Santa Ana <br />Planning Division <br />P.O. Box 1988 <br />M-20 <br />Santa Ana, CA 92702 <br />ACORD 25 (2009/09) <br />INS025 (200909) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />ties Ormaza/NOYOLA <br />®1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />