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SCOTFAZ-01 ROSEM
<br />ACC3RQn
<br />�..._- CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />1013012012
<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 License # OE67768
<br />IOA Insurance Services - SD
<br />4350 La Jolla Village Drive, Suite 900
<br />San Diego, CA 92122
<br />CONTA
<br />NAME:' Ali Smith
<br />HFAX
<br />OONN Ext): (619) 574-6220 ,vo N,); (619) 574-6288
<br />MAIL
<br />AODREss: ali.smith@ioausa.COm
<br />INSURER(S) AFFORDING COVERAGE NAIC i
<br />INSURERA : RLI Insurance Company 13056
<br />INSURED
<br />Scott Fazekas &Associates, Inc,
<br />17777 Del Paso Drive
<br />Poway, CA 92064
<br />INSURER B: Valley Forge Ins CO 20508
<br />INSURER C: Continental Casualty Company 20"3
<br />INSURERD:
<br />INSURERS
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTH E IN SUR ED NAMED ABOVE FORTH E POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />MMIDDNYY
<br />EXP
<br />MMIDCDIYYYY
<br />LIMITS
<br />I
<br />GENERAL LIABILITY
<br />G
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />7
<br />PSBOOD302ZY
<br />O61L7Q
<br />wv
<br />615/201:3
<br />L)AMAC-;L 10 PLIN ED
<br />PREMISES (Ea occurrence) $ 1,000,000
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL&ADVINJURY $ 1,000,000
<br />GENERA.LAGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />I I7 -4
<br />POLICY X JPERO- LOC
<br />E
<br />$
<br />AUTOMOBILE LIABILITY�At
<br />C
<br />-71
<br />UOi11C y
<br />COMBINED NGL LIMIT
<br />(Ea accident) $ 1,000,000
<br />BODILY W URY (Per person) $
<br />A
<br />ANY AUTO
<br />PSB0003027
<br />6/5/2012
<br />6/5/2013
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />X HIREC AUTOS X NON -OWNED
<br />AUTOS
<br />P Y AMA, $
<br />(For accidentl
<br />X No Co. Owne
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR.
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0001119
<br />61512012.
<br />615/201.3
<br />Ar,OREGATE $ 1,000,000
<br />OED FX I RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION.
<br />AND EMPLOYERS'LIABILITYYIN
<br />ANY PRO PRIETORIPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N./A
<br />030731668
<br />6/512012
<br />6/5/2013
<br />X WC STATU- I OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L_DISEASE -EAEMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />E . DISEASE -POLICY LIMIT $ 1,000,000
<br />C
<br />Prof Liab/Clms Made
<br />VICH288352513
<br />615/2012
<br />6/512013
<br />Per Claim 1,000,000
<br />C
<br />Ded.: $20k Per Claim
<br />VICH288352513
<br />6/512012
<br />6/5/2013
<br />Aggregate 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re: All Operations
<br />City of Santa Ana, its officers, employees, volunteers, representatives and agents are Additional Insured with respect to General Liability per the attached
<br />endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions..
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05)
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />City of Santa Ana
<br />—T— l
<br />20 Civic Center Plaza (MI -20)
<br />I
<br />Santa Ana,CA 92702
<br />G
<br />ACORD 25 (2010/05)
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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