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?'`?? °? CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YVYY) 03/ 12/20'12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(Ies) must be endorsed. If SUBROGATION Is WAIVED, subJect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AFFINITY INSURANCE SERVICES INC PHONE Fax A/C No Ext BBB 66'1-3933 A/C No 386 672-692'1 159 E COUNTY LINE RD E-MAIL HATBORO PA 19040 D Servica.mnte lers.corn , (888) 661-3938 PRODUCER 1 353 0 31 01 x051 7 700 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A:TRAVELERS PROPERTY GA3VALTY COMPANY OF AMERICA SCOTT A BOURDELAIS, INSURER B: ATTORNEY AT LAW INSURER C: 2060 N TUSTIN AVE SANTA ANA CA 27 INSURER D: , 9 05 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1 7573921 5431 950 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL INSR SUBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABIITY X 680-35 F63659-1 1 06/01 /201 1 06/01 /201 2 EACH OCCURRENCE $1 OOO OOO X COMMERCIAL GENERAL LIABILITY DAMA RENT D P EM E o $300,000 CLAIMS-MADE ? OCCUR MED EXP An one arson $5 000 X HIRED AVTO PERSONAL 8 ADV INJURY $ 1 .000,000 X NON OWNED AUTO GENERAL AGGREGATE $2 000 DOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2.000,000 PRO- x POLICY JECT LOC $ AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accitlant) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accltlenl) $ HIRED AUTOS --?,? /f(( L.O?lY> LL PP eO ac RtlTY DAMAGE NON-OWNED AUTOS ?? T? $ RoV $ UMBRELLA LIAB OCCUR ? _ EACH OCCURRENCE $ E%CESS LIAB CLAIMS-MADE ? g-T OR K AGGREGATE $ DEDUCTIBLE L? A E ?ty P.tt C n2Y $ RETENTION $ ? t .. tan WORKERS COMPENSATION ' N/A ? / WC STATU- OTH TORY LIMITS ER AND EMPLOYERS LIABILITY Y/N ANY PROPRIETOR/PARTNE R/EXECUTIVE ? E.L. EACH ACCIDENT $ ? OFFIC ER/MEMBER EXCLUDED (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe untler SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 10t, Addlflonal Remarks Schedule, If more space Is r¢qulr¢d) AS RESPECTS TO GENERAL LIABILITY, CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES IS ADDITIONAL INSURED -VENDORS BROAD FORM CG T3 30. I:CK I Ir-IGA I E nOLOEK GAN GELLA7 ION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN: PURCHASING DEPARTMENT EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE 20 CIVIC CENTER PLAZA WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE ( ? ? • ?_'Tr ©'1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD