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CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/WYY)
<br />06/03/2011
<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(les) 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 />Insurance Office of America, Inc.
<br />DBA IOA Insurance Services
<br />1775 Hancock Street, Ste. 180
<br />CONTACT NAME: Sara Cabral
<br />ac NN 619.574.6220 FvcNo;619.574.6289
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER
<br />San Diego, CA 92110
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: RLI Ins Co 13056A
<br />Scott Fazekas & Associates, Inc.
<br />INSURER B: CNA Insurance Companies
<br />9 Corporate Park Drive
<br />Irvine, CA 92606
<br />INSURERC: Continental Casualty Co 20443
<br />INSURER D:
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 11/12 GL/AU/UM/WC/PL 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 />ADDL
<br />INSR
<br />SUBR
<br />W VD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICYEXP
<br />MM/DDIY YY
<br />LIMITS
<br />Sa to Ana, CA 92702
<br />GENERAL LIABILITY
<br />PSB000302
<br />06/05/2011
<br />06/05/2012
<br />EACH OCCURRENCE $ 1.000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TISESO RENTED $ 300,000
<br />CLAIMS -MADE FX] OCCUR
<br />MED EXP (Any one para,,) $ S.000
<br />A
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ Z' 000, 000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG S 2,000,000
<br />POLICY X JECT LOC
<br />r�vf
<br />f v
<br />$
<br />AUTOMOBILE LIABILITY
<br />PSBO 30
<br />06/05/2011
<br />06/05/2012
<br />CO aBBINEDtSINGLE LIMIT $ Included
<br />A
<br />ANY AUTO
<br />ALL OWNED AUTOS',
<br />SCHEDULEDAUTOS
<br />X HIRED AUTOS
<br />Y
<br />//��
<br />I
<br />(I
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per s„itls,l) $
<br />H�
<br />M—r(Per
<br />PROPERTY DAMAGE $
<br />accident)
<br />NON -OWNED AUTOS
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />PSE000111
<br />06/05/2011
<br />06/05/2012
<br />EACH OCCURRENCE $ 1.000.000
<br />AGGREGATE $ 1, 000, 000
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />$
<br />X RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / NTORY
<br />ANPROPRIET ER EXCLUDED? ECUTIVE=
<br />OFFI(Mandatory In NH)
<br />N / A
<br />4030731668
<br />06/05/2011
<br />06/05/2012
<br />X I WC STAru- OTH-
<br />ER
<br />E.L. EACH ACCIDENT $ I. 000 , OO
<br />E.L. DISEASE - EA EMPLOYEE $ 1.000 , 000
<br />I! yes. tlescribe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1 ,000 , 000
<br />k*
<br />ro essiona LTa i ,ty
<br />MCA298352513
<br />$20,000 DEDUCTIBLE
<br />06/05/2011
<br />06/05/2012
<br />$1,000,000 each claim
<br />$1,000,000 aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (A-1, ACORD 101, Additional Remarks S,hsduls, if more spas Is ,squired)
<br />e: All Operations of the Named Insured
<br />it y of Santa Ana, its officers, employees, volunteers, representatives and agents are
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Fred , Plan Mgr
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza CM20�
<br />20 Ci Center Plaza 03
<br />P.O. Box 1988
<br />Sa to Ana, CA 92702
<br />Kelly Howell CABRAS
<br />© 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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