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<br />A� °® CERTIFICATE OF LIABILITY INSURANCE
<br />D03 /30/DDn 1
<br />03/30/2011
<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. ^ I +T 3
<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). r 1 ' Y
<br />PRODUCER OD08408 1- 415 -541 -7900
<br />Wells Fargo Insurance Services USA, Inc.
<br />CONTA :I
<br />NAME: '
<br />PHONE FAX
<br />Ex AIC No
<br />ADDRESS:
<br />45 Fremont Street
<br />Suite 800
<br />San Francisco, CA 94105
<br />INSURERS AFFORDING COVERAGE
<br />NAIC II
<br />INSURERA: FIRST MERCURY INS CO
<br />10657
<br />04/01/1
<br />INSURED
<br />INSURER B; HARTFORD FIRE IN CO
<br />19682
<br />Crown Building Maintenance Company Inc.
<br />DBA: Able Building Maintenance Company Inc.
<br />INSURER C: FEDERAL INS CO
<br />20281
<br />INSURER D: AMERICAN ZURICH INS CO
<br />40142
<br />868 Folsom Street
<br />INSURER E: COLONY INS CO
<br />39993
<br />San Francisco, CA 94107
<br />CLAIMS -MADE rx� OCCUR
<br />INSURER F :
<br />COVERAGES r.FRTIFICATF NUMRFR! 20435004 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 />SUBR
<br />Jm
<br />POLICY NUMBER
<br />MMIDDIYYYY
<br />MW 1 DY EXP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />FMMI024933
<br />04/01/1
<br />04/01/12
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />PREMISES Ea N "once 1
<br />$ 50,000
<br />CLAIMS -MADE rx� OCCUR
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL BADVINJURY
<br />$1,000,000
<br />X $10,000 SIR Each OCC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />�.. -��
<br />-
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OPAGG
<br />$2,000,000
<br />$
<br />POLICY X jE,'j LOC
<br />/ -
<br />�(
<br />B
<br />AUTOMOBILE LIABILITY
<br />57
<br />1
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />`■
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />'�~
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />P r eccid nt
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />g
<br />X $250 X Actual Cash
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />79820671
<br />04/01/1
<br />04/01/12
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />AGGREGATE
<br />$ 10, 000, 000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? 11
<br />NIA
<br />WC8298257 -08 & WC8298258
<br />0 4/01/1
<br />04/01/12
<br />X WCSTATT- 0TH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1, 000, 000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1, 000, 000
<br />D
<br />Workers' Comp. /Employers
<br />WC8298258 -08 (AOS)
<br />04/01/1
<br />04/01/12
<br />Retro Program 150,000
<br />E
<br />Pollution Liability
<br />CPL300516
<br />04/01/1
<br />04/01/12
<br />Each Poll. Cond. 1,000,000
<br />D
<br />Workers' Comp. /Employers
<br />WC8298257 -08 (CA)
<br />04/01/1
<br />04/01/12
<br />Deductible 350,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
<br />Job -Site: 60 Civic Center Plaza. City of Santa Ana Police Department are named as additional insured per attached. This
<br />insurance coverage is primary and non - contributory.
<br />199 x11,71ti\1-IIIIIIN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana Police Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Manager Caddell /Communications
<br />60 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />- I USA
<br />01988 -2010 ACORD CORPORATION. All rights, reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1 4I
<br />aditty
<br />20435009
<br />
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