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N?2012 - 05l <br />.4coRO CERTIFICATE OF LIABILITY INSURANCE <br />?? DATE (MM/DD/YYYV) <br />5/3/2012 <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 req ulre an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in Ileu of such endorsement(s). <br />PRODUCER CONTACT FLl CharCl Alasna <br />NAME: <br />ISU/San Francisco PHONE _ (415) 788-9810 A/C No : (915)298-3539 <br />201 California $t. , $111 te: 200 ADDRE ra109na@isU JrOUp. COm <br />Li tense # 0776092 PRODUCER QQ QQ 121Q <br />San Francisco CA 94111-5098 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURERA:Vallel FOr a Insurance COm a1.1 '0108 <br /> INSURERB:COn tlnBntal Casualt ? 0443 <br />Tharlnotest, Inc INSURERC American Casualt Co. o£ .0427 <br />600 MARTIN AVE <br />INSURER D <br />SUITE 206 <br />INSURER E <br />ROHNERT PARK CA 94 92 8 INSURER F <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WF)ICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. ? ? t ? + <br />ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF <br />M M/DD/YYYY POLICY EXP <br />MM/DD/WYY LIM4T5 <br /> GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2, 000, QQQ <br /> }[ COMMERCIAL GENERAL LIABILITY DAMA E TO RENTED <br />errenre <br />I <br />a <br />$ 300, 000 <br />A CLAIMS-MADE ? OGGDR 017886232 12/10/2011 2/10/2012 ( y parson) <br />MED E <br />XP An <br />on $ 10,000 <br /> PERSONAL 8 ADV INJURY $ 2 , 000 , 000 <br /> GENERAL AGGREGATE $ 4, QQQ, QQQ <br /> <br /> GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS -COMP/OP AGG $ 4 , OOO , 000 <br /> POLICY X PRO- LOC $ <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />$ 1, 000, 000 <br /> (Ea accitlan[) <br /> <br />A ANY AUTO <br />ALL OWNED AUTOS <br />017886232 <br />12/10/2011 <br />2/10/2012 BODILY INJURY (Par parson) $ <br /> BODILY INJURY (Per accident) $ <br /> SCHEDULED AUTOS <br />PROPERTY DAMAGE <br /> X <br />HIRED AUTOS <br />(Per accitlen[) $ <br /> X NON-OWNED AUTOS $ <br /> <br /> ][ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4 ,QQQ ,QQD <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4, QQQ, QQD <br /> DEDUCTIBLE $ <br />B RETENTION $ 4017887557 12/10/2011 2/10/2012 $ <br />C WORKERS COMPENSATON <br />AND EMPLOYERS' LIABILITY X WC STAT U- GTH- <br /> Y / N <br /> ANV PROPRIETOR/PARTNER/EXECUTIVE <br />" <br />? <br />N/A EL EACH ACCIDENT $ 1 QDQ QQQ <br /> OFFICER/MEMBER EXCLUDED <br />T <br />(Mantlatory In NH) 017886327 12/10/2011 2/10/2012 <br />E.L. DISEASE - EA EMPLOYE <br />$ l 000 000 <br /> If yes, tlescnba untlar <br />DESCRIPTION OF OPERATIONS below INCL . USL 6R COVERAGE <br />E.L. DISEASE -POLICY LIMIT <br />$ 1 000 000 <br />A Contractors Equipment 017886232 12/10/2011 2/10/2012 g85,o0o Replacement cost •'A11 Ri slc •' <br />DESCRIPTON OF OPERATIONS /LOCATIONS /VEHICLES (AttacM1 ACORD 101, Atltlitional Remarks Schetlule, iI more space is required) <br />Tl-/e City o£ Santa Ana, its o£ s ??jj `?a9lIQ$??ttjjt?7 (( e??p$$loy??eea9, `CQp{{??9ul tents, spacial counsel, and rapraaantativea era Hamad <br />additional insureds i£ requir lb?l t?Ar ??Gox{"$rhot9.?to?a5<.Ad?iblla primary- <br />aU ? ..(( .. i c:Cul ? <br />Assista?- C_Ly ?1i(r>rTtC'? <br />Clerk o£ the City Council <br />City o£ Santa Ana <br />20 Civic Center Plaza (M-30) <br />P.O. Box 1986 <br />Santa Ana, CA 92702-1986 <br />ACORD 25 (2009/09) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTCE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Alesna/RICHA ? ?- G <br />© '1988-2009 ACORD CORPORATION. All rislhts reserved. <br />INJUZS (200909) I ne AI.V RU name ana IOgO are reglsLBreO marKS OT AGVKV