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`?`? ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/VYYY) <br /> 08/l O/20? 2 <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 BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE <br />OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONA INSEDa,ti thA j?olicy(ies) must ba endorsed. If SUBROGATION is WAIVED, subject to the <br />terms and conditions of the policy, certair?(q?ir?n?re a ?n aildorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsemerfi?t?Ys`'f- <br />PRODUCER <br />I "r'r (? CONTACT <br />NAME' <br />. , t 1"? <br />AFFINITY INSURANCE SERVICES INC CITY PHONE FAX <br />(r ? 1 <br />1 q (A/C, No, Ex U: (B08) 661-3938 IA/C, No): 1988) 872-9921 <br />. <br />l59 E COUNTY LINE RD ?L?ti _ , ''??gc L E-MAIL <br /> <br />HATBO RO, PA "19040 service.centar@vavelars.com <br />(888) 661 -3938 PRODUCER <br />' <br /> 1656C6tOt <br />T M R p- <br />X051 7 700 INSU RERI S) AFFORDING COVERAGE NAIC l/ <br />INSURED INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br />SCOTT A BOURDELAI S, d? l? ?t p?y /^1?? <br />/? <br />? <br />+( <br />ATTORNEY AT LAW <br />' <br />?? <br />INSURER B: <br />.. <br />? <br />JVJ <br />/- <br />/V ?OL? i <br />2060 N TUSTIN AVE INSURER C: <br /> <br />SANTA ANA <br />CA 92705 INSURER D: <br />, INSURER E: <br /> INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 51 544880535 7 322 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 ANV 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, EXCLUSIONS <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- <br />INSR <br />LTR <br />TYPE OF INSURANCE ADDL <br />INSR SUBR <br />POLICY NUMBER POLICY EFF <br />MM/DD/YYYY POLICY EXP <br />MM/DD/VYYY <br />LIMITS <br />A GENERAL LIABIITY X 680-35F63659-1 2 06/01 /20'I 2 06/01 /201 3 EACH OCCURRENCE $ l 000 000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br />5 300,000 <br /> CLAIMS-MADE ? OCCUR MED EXP (An one arson) S 5,000 <br /> x MIREU AUTO <br /> X PERSONAL & ADV INJURY $ l ,000,000 <br /> NOH OwNLO AUTO <br /> ENERAL AGGREGATE 5 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODU T -COMP OP AGG 5 2,000,000 <br /> PRO- <br />x POLICY JECT LOC <br />$ <br /> AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />(Ea accitlenU $ <br /> ANY AUTO <br />ALL OWNED AUTOS BODILY INJURY (Per personl $ <br /> SCHEDULED AUTOS BODILY INJURY (Per accident) 5 <br /> HIRED AUTOS PROPERTY DAMAGE <br />fPer accident) <br />°+ <br /> NON-OWNED AUTOS °+ <br /> <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE 5 <br /> DEDUCTIBLE <br /> RETENTION S <br /> WORKERS COMPENSATION <br />AND EMPLOYERS' UABI LITV Y/N N/A WC STATU- OTH <br />TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br />FF <br />R <br />M <br />E.L. EACH ACCIDENT <br /> ICE <br />/ <br />O <br />EMBER EXCLUDED? <br />(Mandatory m NH) E.L. DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />5 <br /> <br />DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD tOl, Additional Remarks Schedule, if mo.e space is required) <br />AS RESPECTS TO GENERAL LIABILITY, CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES ARE <br />ADDITIONAL INSURED -VENDORS BROAD FORM, CG T3 30 . <br />a.cr? t Irla.h • c rlvt_vcr? GArVGCLLA 1 IVN <br /> <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />AND EMPLOYEES EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE <br />20 CIVIC CENTER WITH THE POLICY PROVISIONS. <br />SANTA ANA, CA 9270'1 <br /> AUTHOflIZED REPRESENTATIVE ? . ?_ <br />T <br />m '1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD