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'A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYV)
<br />12212013
<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, 'DDES'NOT GONSTITUT15-11 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 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 91367
<br />www.venbrook.com
<br />CONTACTNAME:
<br />_
<br />PHONENo. Extl: 818-598-8900 -__ FAX1nIc
<br />_ __818-598-5687
<br />E-MAIL ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC K
<br />INSURER A: Hartford Casualty Insurance29424
<br />LIMITS
<br />INSURED
<br />Overland Pacific & Cutler Inc.
<br />3750 Schaufele Avenue, Suite 150
<br />Long Beach CA 90808
<br />INSURER B: Hartford Fire Insurance Company
<br />_
<br />_
<br />Western World Insurance Company
<br />13196
<br />— —
<br />-INSURER
<br />INSURER D
<br />6/1/2014
<br />INSURER E : ----
<br />— -------- ------—_T_
<br />INSURER F:
<br />COVERAGES CFRTIFICATF NLJMBER: 1RAAQRR1 REVISION NUMBER:
<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 />I
<br />LTRDDIYYYY
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WM SUER
<br />POLICY NUMBER
<br />MMIDDYIYYYY
<br />POLICY
<br />MM
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />,/
<br />72UUNTR7859
<br />6/1/2013
<br />6/1/2014
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAGE TO RENTED 300,000
<br />PREMISES (Ea occurrence) $
<br />—✓
<br />COMMERCIAL GENERAL LIABILITY
<br />MED EXP (Any one person) $ 10,000
<br />J CLAIMS -MADE OCCUR
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />/ —$_10,000 BI&PD Ded.
<br />_
<br />Per Claim
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />$
<br />17 POLICYF,/ PRO ,/ LOC
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />72UUNTR7859
<br />6/1/2013
<br />6/1/2014
<br />1 COMBINED SINGLE LIMIT
<br />a accident -$--- _ –1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />_—
<br />ALL OWNED SCHEDULED
<br />AUTOS _✓_ AUTOS
<br />I NON -OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />rPROPERTY DAMAGE
<br />Per accidentk -, $
<br />Comp Ded $1,000
<br />$
<br />Coll Ded $1,000
<br />A
<br />UMBRELLA LIAB /
<br />✓li
<br />OCCUR
<br />72RHUTR7849
<br />6/1/2013
<br />6/1/2014
<br />EACH OCCURRENCE $ 2,000,000
<br />AGGREGATE $ 2,000,000
<br />EXCESS LIAR..
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />$
<br />—
<br />$
<br />A WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROP RIETOR/PARTNE R/EXEC UTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />172WEDQ4300
<br />6/1/2013
<br />III
<br />6/1/2014
<br />WCSTATW-
<br />.TORY LIMITT S ER,i
<br />_
<br />E.L. EACH ACCIDENT $ 1,000000
<br />- ----
<br />E.L. DISEASE - EA EMPLOYEE $ 1 000. 000
<br />in NHder
<br />!
<br />If yes,
<br />Cnytldesaribe
<br />DESCRIPTION OF OPERATIONS belcw
<br />-_
<br />E.L. DISEASE - POLICY I-IMIT$ 1,000,000
<br />C
<br />Professional Liab.
<br />-----t--
<br />I BRL0004324
<br />6/1/2013
<br />--+---
<br />6/1/2014
<br />1$2,000,000 Each Claim
<br />Claims Made
<br />$2,000,000 Aggregate
<br />Retro Date: 6/3Q/0
<br />50 000 Deductible
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<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) on primary & noncontributory basis where required by contract. Subject to policy terms, conditions,
<br />and exclusions. '10 Days notice of cancellation for non-payment of premium, `30 days notice of cancellation anyother reason.
<br />r
<br />CERTIFICATE HOLDER NCELLATION
<br />MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Public Works Agency, M-36 ---"Laura Stitt e y CORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988 Assistant iiv 4ttorne
<br />Santa Ana CA 92702 Y AUTHORIZED REPRESENTATIVE
<br />WH Yvonne Sharp
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />CERT NO.: 16449661 (WH) Lindaay Moss 5/22/2013 4:00:15 PM Page 1 of 5
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