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,acoRo CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IM""I°°"'"'I
<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 an ADDITIONAL INSURED, the policy {ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terns 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 />SPIB Insurance Agency, Inc.
<br />License Number 0719264
<br />26441 Crown Valley Parkway #200
<br />Mission Viejo CA 92691 -
<br />CONTACT Amy Alberding
<br />PHONE (949)T582 -5220. FA (949)582 -3312
<br />AMESS:amy8spib..COm
<br />RODUCERI 00000369
<br />INSURER(S) AFFORDING COVERAGE -
<br />NAIC8
<br />FRED
<br />Rue Vac Property Services Inc
<br />600 W. Taft Avenue �Q a ©!!
<br />I /) _ D/ .
<br />Orange CA 92865 J�
<br />INSURERA:Peerless Insurance Co
<br />24198 ' GE
<br />INsURERB:The Netherlands Insurance Co
<br />24171 GE
<br />INSURER c :Golden Eagle Insurance" Corp.
<br />10836
<br />INSURER D:
<br />EACH OCCURRENCE
<br />INSURER E
<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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPEOFINSURANCE
<br />POLICY NUMBER
<br />WD EFF
<br />MMYEXP-
<br />IY
<br />LIMITS
<br />GENERAL LIABWTY
<br />EACH OCCURRENCE
<br />$ 1'000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />PREMI�adcurrence
<br />$ 100,000
<br />A
<br />CLAIMS-MADE a OCCUR
<br />=9558563
<br />/1/2012
<br />/1/2013
<br />MED EXP (Any one person )
<br />$
<br />PERSONAL S:ADVINJURY
<br />S 1,000,000
<br />-
<br />-
<br />_ --
<br />GENERAL AGGREGATE
<br />'$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - CONIMP AGG
<br />$ 2,000,000
<br />X POLICY PRD LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED.3INGLE LIMIT
<br />$ 1, 000 000
<br />XANY
<br />AUTO
<br />(Ea accident)
<br />,
<br />BODILY INJURY (Per parser)
<br />$
<br />B
<br />ALL OWNED AUTOS
<br />79.7086
<br />./l/2012
<br />/1/2013
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />X
<br />HIRED AUTOS
<br />(Per acadent)
<br />$
<br />X
<br />NON-OWNED AUTOS
<br />-
<br />Underinsured motwst property
<br />S
<br />Medical payments
<br />$
<br />-
<br />C
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS-MADE
<br />U9558863
<br />AGGREGATE
<br />S 1,000,000
<br />DEDUCTIBLE
<br />S
<br />RETENTION S
<br />/1/2012
<br />/1/2013
<br />$
<br />WORKERS COMPENSATION
<br />-
<br />tM1IC STATU- OTH-
<br />AND EMPLOYERS LIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />$
<br />ANY PROPRDFrCRJPARTNER/EXECUTNE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />EE SCIF CERT
<br />-
<br />(Mandatory in N
<br />U yyeess descrbe Und
<br />i nd er
<br />D IPTION OF OPERATIONS beiwi
<br />E.L. DISEASE - EA EMPLOYE
<br />$
<br />E.L. DISEASE - POLICY UMrr
<br />$
<br />A
<br />PROPERTY SPECIAL FORM
<br />,
<br />=W9558563
<br />/1/2012
<br />/1/2013
<br />BUILDING 3.,2.48,480
<br />REPL COST $1000 DED
<br />BUS PERSONAL PROPERTY 104,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
<br />RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 S. SANTA ANA BLVD., SANTA ANA, CA. -
<br />TEE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, _VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS ADDITIONAL
<br />INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM GECG 602 (09/04) SECTION V, A 6 B. PRnOM AND
<br />NON - CONTRIBUTORY WORDING I3 PROVIDED IN FORM # 22 -111 01/07.
<br />✓ SHO=ANY OF THE ABOVE: DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOp, NOTICE WILL BE DELIY£RED IN
<br />THE CITY OF SANTA812ii1 ,`+;:Lt i,e�cy ACCORDANCEVVITHTHEPOLICYPROVISIONS.
<br />20 CIVIC CENTER PLAZAP, tS15Ec ^OC �i,ii.Y !'�tTGiT',ne3'
<br />SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE
<br />Hines, CPCU ARM CIM '� y
<br />Amnon os: iannmmn,
<br />--� lJ- I`Jaa -LYuV AUUK1) UUKPOKATION. All rights reserved.
<br />INS026 ( ma
<br />The ACORD name and logo are registered rks of ACORD
<br />
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