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.ACCORD CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMMD IYYY)
<br />`�
<br />3/1/2012
<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 are ADDITIONAL INSURED, the policy(ies) must be endorsed. It 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
<br />CONTACT A-y Alberdinq
<br />NAME
<br />SPIB Insurance Agency, Inc.
<br />PHONE (949)) 582-5220 An No: (949)582-35.2
<br />License Number 0719264
<br />E-MAIADDR�;amyLspib..com
<br />26441 Crown Valley Parkway#200
<br />PRODUCER CUSTOMER 000003.69
<br />Mission Viejo CA 92691
<br />INSURER(S) AFFORDING COVERAGE
<br />NA1Ca
<br />INSURED
<br />INSURERA:Peerless Insurance Co
<br />24198 GE
<br />INsuRERB:The Netherlands Insurance Co
<br />24171 GE
<br />Rue Vac Property Services Inc
<br />600 W. Taft Avenue /! `Ol/
<br />a ©
<br />lNsuRERc:dolden Eagle Insurance, Co
<br />0836 GM
<br />INSURER D:
<br />INSURERE: -
<br />_9 `o
<br />Orange CA 92865 J�
<br />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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER .
<br />> POLICYEFF
<br />ICY E7fP
<br />LIMITS
<br />GENERAL LIABILITY
<br />-
<br />-
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />X COMMERCIAL GENERAL UABIUTY
<br />CLAIMS -MADE a OCCUR
<br />9558563
<br />/1/2012
<br />/1/2013
<br />_eREA E(ocwrrencel
<br />$ 1 000
<br />MED
<br />EDEXM
<br />P one person
<br />$ . 5 .000
<br />.5,
<br />PERSONAL &:ADV INJURY
<br />$ 1,000,000
<br />..
<br />..
<br />..
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />JECT X POLICY71 PRO- LOC
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />§
<br />AUTOMOBILE
<br />X
<br />LJASIUTY
<br />ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />S I, 000 , 000
<br />BODILY INJURY {Per person)
<br />$
<br />B
<br />ALL OVMED AUTOS
<br />BA9797086
<br />/1/2012
<br />/1/2013
<br />BODILY INJURY (Per accident)
<br />S
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />X
<br />HIRED AUTOS
<br />X
<br />NON -OWN® AUTOS
<br />Underinsraed neo[orct property
<br />$
<br />Medical payments
<br />$
<br />C
<br />U1RBRlI.LA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X1
<br />EXCESS LIAS
<br />CLAIMS -MADE
<br />rU9558863
<br />AGGREGATE
<br />S 1,000,000
<br />DEDUCTIBLE
<br />§
<br />RETENTION S
<br />/1/2012
<br />/1/2013
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/D(ECUTNE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in under
<br />If yes nd
<br />DESCRIPTION OF OPERATIONS belwa
<br />-
<br />NIA
<br />_
<br />EE SCIF CERT
<br />-
<br />- -
<br />WCSTATU- OTH-
<br />'E.L EACH ACCIDENT
<br />§.
<br />E.L. DISEASE - EA EMPLOYE
<br />$
<br />E.L. DISEASE - POLICY LIMR
<br />$
<br />A
<br />PROPERTY , SPECIAL FORM
<br />MP9556563
<br />/1/2012
<br />/1/2013
<br />BUILDING 1,2.48,480
<br />REPL COST $1000 DED
<br />BUSPERS,gIrtALPROPERTY 104,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space's required)
<br />RE: SANTA ANA, REGIONAL TRANSPORTATION CENTER, 2000 E. SANTA ANA BIND_, SANTA ANA, CA. -
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS ADDITIONAL
<br />INSUREDS WITS RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM GECG 602 (09/04)- SECTION V, A 6 B. PRnOLRY AND
<br />NON-CONTRIBUTORY WORDING IS PROVIDED IN FORM # 22-111 01/07.
<br />s•.
<br />THE CITY OF SANTA =M aura at i,eecy
<br />20 CIVIC CENTER PLAZAAs�istani Cify Attorney
<br />SANTA ANA, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Hines , CPCU ARM CLUi/
<br />ACORD 25 (2009/09)
<br />n.rcnee ..............
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />- . ......-....... I—— r - -119- 4110 K CV14LWCU RedrKS OT AL UKt1
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