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OP ID:
<br />`??? ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />1 2/01 J11
<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 endorsements .
<br />PRODUCER 650-393-2000 CAOMTACT -
<br />San Francisco P&C 650-393-2001 feHONE ?? F,?
<br />Hays of California Ins Service
<br />1350 Bayshore Hwy, Suite 218
<br />3urlingame, CA 94010
<br />INSURED ICLEI USA Inc
<br />180 Canal Street #401
<br />Boston, MA 02114
<br />nsurance Co_ 19682
<br />Ince Company 20281
<br />ndon Companies
<br />rr'i?/ovnr_rc - ---
<br />------- ------ "-°'-?'?' RCVIJ?VAV IVUM 6CK:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOV
<br />E FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WH
<br />ICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB
<br />JECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS.
<br />INSR TYPE OF INSURANCE ADDL SUBR
<br />POLICY NUMBER POLICY EFF POLICY EXP ? LIMITS
<br /> GENERAL LIABILITY
<br /> EACH OCCV RRENCE $ 1,000,00
<br />B X COMMERCIAL GENERAL LIABILITY X X 35893974 11/26/11 11/26/12 1
<br /> PREMISES Ea occurrence ,000,00
<br />$
<br /> CLAIMS-MADE ? OCCUR
<br /> MED EXP (Any one parson) $ 10,00
<br /> PERSONAL 8 ADV INJURY 1
<br />000
<br />00
<br /> $
<br />,
<br />,
<br /> GENERAL AGGREGATE 2
<br />000
<br />00
<br /> ,
<br />$
<br />,
<br /> GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO PRODUCTS -COMP/OP AGG $ 2,000,00
<br /> X POLICY
<br />LOC $
<br /> AUT OMOBILE LIABILITY X COMBINED SINGLE LIMIT
<br />
<br />B
<br />ANV AUTO
<br />
<br />73549972
<br />
<br />11/26/11
<br />
<br />11/26/12
<br />
<br />(Ea acdtlenq $ 1,000,00
<br />
<br />X
<br />ALL OWNED AUTOS BODILY INJURY (Par person) $
<br /> SCHEDULED AUTOS
<br />BODILY INJURY (Par accitlent)
<br />$
<br />
<br />X
<br />HIRED AUTOS PROPERTY DAMAGE
<br />(Par accltlent)
<br />$
<br />
<br /> X NON-OWNED AUTOS $ ,
<br /> NO OWNED AUTOS $
<br /> )( UMBRELLA LIAB OCCUR 2
<br />00
<br /> EACH OCCURRENCE ,
<br />$
<br />0,00
<br />
<br />B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2
<br />000
<br />00
<br /> X 7983-82-51 11/26/12 11/26/12 ,
<br />,
<br /> DEDUCTIBLE
<br /> $
<br /> RETENTION $
<br />$
<br /> WORKERS COMPENSATION
<br />' X WC STATU- OTH-
<br /> AND EMPLOYERS
<br />LIABILITY ?, / N
<br />A ANY PROPRIETOR/PARTN ER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ?
<br />N / A 57WECLX9368 11/01/11 11/01/12 E.L EACH ACCIDENT $ 1,000,00
<br /> (Mantlatory In NH)
<br />If yes describe under E.L. DISEASE - EA EMPLOYE $ 1,000,00
<br /> DESCRIPTION OF OPERATIONS belo
<br /> w
<br />E_L DISEASE-POLICY LIMfT $ 1,000,00
<br />C Errors 80missions ME01039869 11/01/10 11/26/11 E 8 O 1,000,OD
<br /> D¢d. 10,00
<br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, AdtllOanal Remarks Sch¢tlule, If more space Is requlretl)
<br />The City of Santa Ana, its officers employees, agents, volunteers and
<br />representatives are named as additlon?l IR)surr? Ith reg?aftl t4 dye 11?b111
<br />and defense of suits arising Trom the'byeraIIa?q? mid-?s?Yy?lertbk+fieff by=b?'k?'1
<br />or or on behaH of the named Insured. Notice of cancellation f r
<br />`:?ula tiu(:. Sl?.ecdy ^..V"M.,•v
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />A ?z,i?lr; ;?I. CiLy F+LlorneY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana (et al) ACCORDANCE WITH THE POLICY PROVISIONS.
<br />(see t)e IOW)
<br />Attn: ChrlSty Klndlg - AUTHORIZED REPRESENTATIVE
<br />P. O. Box 1988, M-21 ? `
<br />Santa Ana, CA 92702
<br />©1988-2009 ACORD CORPORATION- All rights reserved.
<br />/+wrcu ca (zuun/Da) Tne ACORD name and logo are registered marks of ACORD
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