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A`CCp"® %r.►�'�!!" CERTIFICATE OF LIABILITY INSURANCE DATE 10/2 fY 2 ol/�0/2012 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 policy(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 1-804-000-0000 Arthur J. Gallagher Risk Management Services, Inc. CONTACT NAME: Carolyn O. Varnier PHONE FAX . No: 804 A/C N Ext: 804-916-6846 -916-6897 E-MAIL ADDRESS: 4860 Cox Road, Suite 200 INSURER(S) AFFORDING COVERAGE NAIC# Glen Allen, VA 23059 INSURER A: LM INS CORP 133600 Carolyn O. Varnier INSURED INSURER B : ICF JONES & STORES, INC. INSURER C : INSURERD: 9300 LEE HIGHWAY INSURER E: FAIRFAX, VA 22031 INSURER F COVERAGES CERTIFICATE NUMBER: 25092492 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 ANY 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. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES Ea occurrence $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ OVcGD AS TOMM GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ i/ POLICY PRO- n LOC $ AUTOMOBILE LIABILITY ( 1 I I COMBINED SINGLE LIMIT Ea accident $ HOWE BODILY INJURY (Per person) $ ANY AUTO A 1 N U. ALL OWNED SCHEDULED AUTOS i AUTOS stitt nt Ci y AtionwIr BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS I AUTOS ! J i $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE' DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC5-Z31-508381-011 06/25/1 06/25/12 X WCSTATU- OTH- T Y LIMIT R E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THE ACADEMY HIGH SCHOOL CERTIFICATE HOLDER CANCELLATION CITY ATTORNEY CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-29) PO BOX 1988 SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE USA 6L� I/r z7 " 1.. Yak1&" ` C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) carolynvar 25092492 The ACORD name and logo are registered marks of ACORD