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. O CERTIFICATE OF LIABILITY INSURANCE
<br />DATE2012/YYYY)
<br />6.
<br />10/24/2012
<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 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 endorsemen s .
<br />PRODUCERCT
<br />NAME:
<br />Rutherfoord
<br />222 Central Park Avenue
<br />PHONE 7-456-0577AIC No :7 7 4 -
<br />MAIL
<br />ADDRESS.
<br />Suite 1340
<br />INSURER(S)AFFORDING COVERAGE NAIC#
<br />Virginia Beach VA 23462
<br />_
<br />INSURERA: I Insurance
<br />INSURED
<br />__10172
<br />INSURERB:Fidelity & Deposit Company of Mary
<br />_._.-
<br />INSURERC:American Zurich Insurance Company 0142
<br />MuniServices, LLC
<br />Patricia Dunn
<br />ph: 559-271-6852
<br />INSURER D:Am ri n Guarantee n Liability In 247
<br />-
<br />INsuRERE:LandmarkAmerican Insurance Com atnny _ _ 1 8
<br />7625 N. Palm Avenue, Suite 108
<br />Fresno CA 93711
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 909180544 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/D
<br />POLICY EXP
<br />MMIDD LIMITS
<br />C
<br />J GENERAL LIABILITY
<br />--
<br />Y
<br />Y
<br />CP0982903802
<br />10/31/2012
<br />0/31/2013
<br />1,000,000
<br />EACH OCCURRENCE 7-1.0-0010-00--
<br />X
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE J OCCUR
<br />__
<br />lPRrASES EaEN.EDnrence 8300,000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL INJURY $1,000,000
<br />_ _
<br />GENERALAGGREGATEi $2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />— --
<br />'..
<br />' X�' PRO- X
<br />POLICY LOC
<br />-.__.
<br />$
<br />C
<br />I AUTOMOBILE
<br />LIABILITY
<br />BAP982902102
<br />10/31/2012 0/31/2013
<br />Ea accident $1,000,000
<br />X
<br />ANY AUTO
<br />_
<br />BODILY INJURY (Per person) $
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS —� AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />—_ AUTOS
<br />BODILY INJURY Per accident $
<br />I ( )
<br />PROPERTY DAMAGE
<br />Per accident)_+$
<br />D
<br />X UMBRELLA LIAB
<br />�LOCC,,UR
<br />UMB982907902
<br />10/31/2012 0/31/2013
<br />EACH OCCURRENCE $10,000,000
<br />EXCESS LIAB
<br />CS -MADE
<br />AGGREGATE $10,000,000
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? N
<br />N / A;
<br />Y
<br />0982903902
<br />'10/31/2012 0/31/2013
<br />X WC STATU- OTH-
<br />] TORY R-�
<br />E.L EACH A CCTS - - -
<br />NT $1,000 000
<br />-- - _.___—_ — _.. _
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - EA EMPLOYEF $1,000,000
<br />— --
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />B
<br />E
<br />Professional Liab(E&O)
<br />Crime
<br />Professional Liab(E&O)
<br />21671630009 T1001'311/120
<br />CCP006253307
<br />LHZ736248
<br />2012
<br />12
<br />1/2012
<br />0/31/2013
<br />0/31/2013
<br />0/31/2013
<br />$2,000,000 Limit
<br />$5,000,000 Limit $25,000 Ded
<br />$3,000,000 Limit Excess Liab.
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />Per the cancellation wording listed on this form, the policy provisions include at least 30 days notice of cancellation except for non-payment of
<br />premium.
<br />The City of Santa Ana, its agents, officers, servants and employees are named as additional insureds under the General Liability policy with
<br />respect to the operations and work performed by the named insured as required by contract.
<br />APPROVED AS TO FORM
<br />VI11\VCLLM
<br />Laura Stitt S eY ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />} THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana Assistant City Attornev ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Finance Director
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702-1988
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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