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2]1069
<br />ACIORV® CERTIFICATE OF LIABILITY INSURANCE DATE(YYY)
<br />Y
<br /> 1//81201
<br />8/2013
<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 .,?[uIENDr EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT C'?IfU'I'E .A ?CyON1?RA(eT kTETWEEN 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 regUire an endorsement. A stateolant on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). I.;'
<br />PRODUCER CONTACT
<br />NAME:
<br />Commercial Lines - (818) 464-9300 BONN
<br />A
<br />C
<br /> Ez
<br />/
<br />No :
<br />Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 EMAIL
<br /> ADDRESS:
<br />15303 Ventura Boulevard, 7th Floor INSURERS AFFORDING COVERAGE NAIC #
<br />Sherman Oaks, CA 91403-3197 INSURERA: Philadelphia Indemnity Insurance Company 18058
<br />INSURED INSURERS: Philadelphia Insurance Company 23850
<br />Discovery Science Center INSURERC: Employers Compensation Ins Cc 11512
<br />2500 North Main Street INSURER D: Travelers Casualty & Surety Co. of America 31194
<br />Santa Ana
<br />CA 92705
<br />, INSURER E :
<br />//11 O
<br />T/
<br /> INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 5465122 REVISION NUMBER: See helew
<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 />Um TYPE OF INSURANCE ADDL
<br />INSR SUBR
<br />MD
<br />POLICY NUMBER POLICY EFF
<br />MMIODIVVYV POLICY EXP
<br />MMIDDNYYY
<br />LIMITS
<br />A GENERAL LIABILITY X PHPK953782 12/15/2012 12/15/2013 EACH OCCURRENCE
<br />_ $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY
<br />TO REN7ET
<br />PREMIESES S
<br />Ea Ea occurrence) PREMI
<br />$ 300,000
<br />
<br /> CLAIMS-MADE OCCUR MED EXP(Anyone person $ 5,000
<br /> PERSONAL &ADV INJURY $ 1,000,000
<br />
<br /> GENERAL AGGREGATE $ 2,000,000
<br />
<br /> GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000
<br /> X POLICY PRO LOO $
<br />A AUT OMOBILE LIABILITY PHPK953782 12/15/2012 12/1512013 COMBINED SINGLE LIMIT
<br />Ea eacldent
<br />1,896,893
<br /> ANY AUTO BODILY INJURY(Per parson) $
<br /> I ALL OWNED
<br />AUTOS SCHEDULED
<br />AUTOS BODILY INJURY Per accident
<br />( ) $
<br /> x HIRED AUTOS X NON-OWNED
<br />AUTOS PROPERTDADAMAGE
<br />Per accident
<br />
<br />B UMBRELLA LIAB X OCCUR PHUB404496 12/15/2012 12/15/2013 EACH OCCURRENCE $ 10,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br />
<br /> DEO RETENTION$ $
<br /> WORKERS COMPENSATION X WC STATU- OTH-
<br />C AND EMPLOYERS' LIABILITY EIG1453813-00 04/01/12 04101/13 TCRYL ER
<br /> YIN
<br />ANY PROPRIETOWPARTNEWEXECUTIVE
<br />F
<br />E
<br />E
<br />B
<br />E
<br />N
<br />/
<br />N/A
<br />E.L. EACH ACCIDENT 1,000,000
<br />$
<br /> OF
<br />IC
<br />R
<br />M
<br />M
<br />ER
<br />XCLUDED?
<br />(Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ 1,000,000
<br /> If yes, describe under
<br />DESCRIPTION OF OPERATIONSbelow
<br />EL.DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D D&O, EPL, Fiduciary, Crime 105645707 0613012012 06/30/2013 sooo,ooo
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />CG 20 26 07 04 The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and
<br />representatives are included as Additional Insureds for General Liability and defense of suits arising from the operations and uses performed by or on
<br />behalf of the Named Insured per the attached. Cancellation Notice to Scheduled Additional Insured also attached. The coverage is primary and
<br />non-contributory with other insurance held by the City. Separation of insureds applicable per the policy form.
<br />FORM,
<br />CERTIFICATE HOLDER CANCELLATION
<br />
<br />City of Santa Ana - O
<br />' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Attn: Risk Management j 7 titt Sjl THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza Assist t City Attorney
<br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
<br />97 ?
<br />ACORD 25 (2010/05)
<br />the ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ITlIS -Iroale,epl- oerllnoe,ea mee 116 issued on I'W. t ,)
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