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L.IYCnIiF. 1 Aay'►o 1 auOutimij V L,vR
<br />ACORD,, CERTIFICATE
<br />OF LIABILITY INSURANCE
<br />1/19; 012""'"'
<br />PRODUCER
<br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
<br />BUTInsurance Services
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />of Orange County
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />680 Langsdorf Drive Suite 100
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Fullerton, CA 92831
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURED
<br />Cordoba Corporation
<br />INSURER A: Sentinel Insurance Company, Ltd 11000
<br />1401 N. Broadway
<br />INSURER B: Everest National Insurance Co 10120
<br />Los Angeles, CA 90012
<br />INSURER C: Property & Casualty Ins Co of H 34690
<br />AGGREGATE
<br />INSURER D: -
<br />INSURER E:
<br />COVFRor;FS
<br />DEDUCTIBLE
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR DDN
<br />INSR TYPE OF INSURANCE POLICY NUMBER
<br />NSR
<br />POLICY EFFECTIVE
<br />DATE MM/DO
<br />POLICY EXPIRATION
<br />DATE MM D
<br />LIMITS
<br />JA [GENERAL LIABILITY 72SBACP3130
<br />01/20/2012
<br />01/20/2013
<br />EACH OCCURRENCE 1$1,000.000
<br />X COMMERCIAL GENERAL LIABILITY
<br />FPCLAIMS MADE a OCCUR
<br />OTHER THAN EA ACC
<br />$-
<br />DAMAGE TO RENTPREMISES =ED 1$1,000,000
<br />MED EXP (Any one person) 1$10,000
<br />PERSONAL &ADV INJURY 1$1,000,000
<br />A EXCESS / UMBRELLA LIABILITY 72SBACP3130
<br />01/20/2012 01/20/2013 EACH OCCURRENCE
<br />1$5,000.000
<br />GENERAL AGGREGATE [$2,000,000
<br />AGGREGATE
<br />1$5,000,000
<br />GGREGATE LIMIT APPLIES PER:
<br />Is
<br />DEDUCTIBLE
<br />PRODUCTS - COMP/OP AGG $2,000000
<br />LICY j CT LOC
<br />X RETENTION $ 10000
<br />Is
<br />WCAUTOMDBILELIABIUrY72UECUS9769 01/20/2012
<br />Y AUTO
<br />01/20/2013 COMBINED SINGLE LIMIT
<br />(Ea accident) $1,000,000
<br />OWNED AUTOSBODILY
<br />EMPLOYERS' LIABILITYLIMITS
<br />HEDULED AUTOS
<br />INJURY
<br />(Per person) $
<br />ED AUTOS
<br />E.L. EACH ACCIDENT
<br />-
<br />N -OWNED AUTOS
<br />BODILY INJURY $
<br />(Per accident)
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
<br />Per form SS0008 04/05 pages 11-13 of 24 attached, the following are named as Additional Insureds, as
<br />respects General Liability, as required by written contract.
<br />Additional Insureds: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702;its
<br />officers, employees, agents and volunteers are named as additional insureds with regard to liability and
<br />defense of suits arising from the operations and uses preformed by or on behalf of the named insured.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />City of Santa Ana - DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An WRITTEN
<br />20 Civic Center Plaza NOTICE TO THE CERTIFICATE HOLDER NAMED TO.THE LEFT, BUT FAILURE TO 00 SO SHALL
<br />Santa Ana, CA 92702-1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2009/01) 1 of 2 #S8070243/M8064223 0 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD LXMCN
<br />PROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />GARAGE LIABILITY
<br />AUTO ONLY - EA ACCIDENT
<br />$NY
<br />A AUTO
<br />OTHER THAN EA ACC
<br />$-
<br />AUTO ONLY: AGG
<br />$
<br />A EXCESS / UMBRELLA LIABILITY 72SBACP3130
<br />01/20/2012 01/20/2013 EACH OCCURRENCE
<br />1$5,000.000
<br />X OCCUR CLAIMS MADE
<br />AGGREGATE
<br />1$5,000,000
<br />Is
<br />DEDUCTIBLE
<br />Is
<br />X RETENTION $ 10000
<br />Is
<br />B WORKERS COMPENSATION AND CA20011117121
<br />01/20/2012 01/20/2013 X - WC STATLJ- OTH-
<br />EMPLOYERS' LIABILITYLIMITS
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEI,,��CC���LL,,I
<br />WFIC5ER/MEMBER EXCLUDED? LN
<br />( an story In LLLLJJJJ
<br />E.L. EACH ACCIDENT
<br />-
<br />$1 000 000 "
<br />If yes, describe under
<br />and
<br />E.L. DISEASE - EA EMPLOYEE $1 OOO 000
<br />SPECIAL PROVISIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />OTHER
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
<br />Per form SS0008 04/05 pages 11-13 of 24 attached, the following are named as Additional Insureds, as
<br />respects General Liability, as required by written contract.
<br />Additional Insureds: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702;its
<br />officers, employees, agents and volunteers are named as additional insureds with regard to liability and
<br />defense of suits arising from the operations and uses preformed by or on behalf of the named insured.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />City of Santa Ana - DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An WRITTEN
<br />20 Civic Center Plaza NOTICE TO THE CERTIFICATE HOLDER NAMED TO.THE LEFT, BUT FAILURE TO 00 SO SHALL
<br />Santa Ana, CA 92702-1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2009/01) 1 of 2 #S8070243/M8064223 0 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD LXMCN
<br />
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