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M
<br />A�'Fb' CERTIFICATE OF LIABILITY INSURANCE
<br />(MMfD
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed.. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement.. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER Venbrook Insurance Services CA. Lic OD80832
<br />6320 Canoga Avenue, 12th Floor
<br />Woodland Hills,. CA 91.367 s
<br />CONTACT NAME;
<br />PHONE- Me.No:
<br />818-598-5687
<br />E-MAIL ADD
<br />POLICY EFF .
<br />M NDD1YYYY
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />www.venbrook.com
<br />INSURERA: 4
<br />INSURED
<br />Overland Pacific & Cutler Inc.
<br />INSURER B: Hartford Fire Insurance Company 19682
<br />INSURER C: Western Mirld Insurance Compal2y 1310
<br />3750 Schaufele Avenue, Suite 150
<br />Long Beach CA 90808
<br />INSURERD:
<br />INSURER E:
<br />EACH $
<br />INSURER F:
<br />GUVERAGES CERTIFICATE N[IMRFR• 1%434128- racVlcinN YJ."RaQ=o-
<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 CONTRACTOR 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 />LTR
<br />TYPE OF INSURANCE
<br />ADD
<br />ma
<br />POLICY NUMBER
<br />POLICY EFF .
<br />M NDD1YYYY
<br />POLICY EXP
<br />MM!
<br />LI$YTS
<br />A
<br />GENERAL LIABILITY
<br />72UUNTR7859
<br />6/1/2012
<br />6/1/2013
<br />EACH $
<br />1,000,000
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />�O,ECCTURRREENCE
<br />PREMFJ E LN17D_bce. $
<br />300,00
<br />MED EXP (Any one person) $
<br />10,00
<br />CLAIMS -MADE OCCUR
<br />✓ $10,000BI&PDDed,
<br />PERSONAL&ADV INJURY $
<br />1,000,00
<br />-Per Claim
<br />GENERAL AGGREGATE $
<br />2,000,00
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />PRODUCTS-COMP/OPAGG $
<br />2,000,00
<br />POLICY �/ JECT PRO- ✓ LOC
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />72UUNTR7859
<br />6/1/2012
<br />6/1/2013
<br />eMBINEED SINGLE LIMIT $
<br />1000 00
<br />ANY AUTO
<br />BODILY INJURY (Per parson) .$
<br />ALL OWNED SCHEDULED
<br />BODILYINJURY(Peraccident) $
<br />AUTOS [�,/
<br />ANONP
<br />UTOSAUTOS
<br />HIREDAUTO5-OWNED
<br />..
<br />P accRldent MAGE. S
<br />Comp Ded $1,000
<br />$
<br />✓
<br />Coll Ded $1.000
<br />$
<br />A
<br />UMBRELLA LIABOCCUR
<br />H
<br />72RHUTR7849
<br />6!112012
<br />6!1/2013
<br />EAcrloccuRRENCE $
<br />2000,000
<br />EXCESS 11AS
<br />CLAIMS -MADE
<br />AGGREGATE $
<br />2,000,00
<br />DED Ll RETENTION $
<br />S
<br />S
<br />S
<br />A
<br />WORKERS ANDBIPLOYER'LIA TIONILII
<br />AND EMPLOYERS LIABILITY YIN
<br />72WETQ9133
<br />6!1/2012
<br />6/1/2013
<br />u�sTATu- Og
<br />TRY LIMBS ER
<br />ANY PROPRIETORfPARTNER/EXECUTIVE
<br />OFFICERIMEMBER, EXCLUDED? F
<br />NIA
<br />E.L. EACH ACCIDENT $
<br />1 000 000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE - EA EMPLOYEE S
<br />1 000,000
<br />E.L. DISEASE -POLICY LIMIT $
<br />1,000 00
<br />DESCRIPTION OF OPERATIONS below
<br />C Professional Uab. BRL0002079 6/15/2012 6/1/2013 $2,000,000 Each Claim
<br />Claims Made $2,000,000 Aggregate
<br />Retro Date:'6/30/03ctible
<br />DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional RernarRa Schedule, V mon apace la ragdnxQ
<br />The City of Santa Ana, its officers, agents, employees, consultants, special counsel & representatives are named as additional insured per attached
<br />endorsement #HG00010605 (excl work comp) primary & noncontributory basis where required by contract. Subject to
<br />policy terms, conditions,
<br />and exclusions. "10 Days notice of cancellation for non-payment of premium, "30 days notice of cancellation anyother reason.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE
<br />Public Works Agency, M-36
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />IN
<br />P.O. Box 1988
<br />b r
<br />Santa Ana CA 92702 APPROVED y ED A ,
<br />A %RRED REPRESENTATIVE
<br />Pamala Nash
<br />~~City F.tI - ®1988-2010 ACORD CORPORATION. All rights rese71,<
<br />ACORD 25 (2010105) The ACORD nMi Pogo areregistered marks of ACORD CERT NO.: 13334906 (WN) Lindsay MOSS 6/14/2012 7:55:21 PDI page 1 of 5
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