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4 A <br />AC" CERTIFICATE OF LIABILITY INSURANCE DATE(0MID° ' <br />2121!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(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 Phone: (31DA78-5041 CONTACT <br />Fa): (310)479-8707 NME: <br />M.G. Skinner & Associate, PHONE ExtI; <br />A X Nal_ <br />-----? -- <br />E-MAIL <br />1 1030 Santa Monica Blvd. ADMESS: <br />Suite 207 INSURER(S) AFFORDING COVERAGE ..^NAIC 0 <br />Los Angeles, California 90025 INSUIRER A : National Union Fire Insurance Company Of Pittsburgh, ? 19445 <br />INSURED INSURER B; Federal Insurance Company 20281 <br />The Act 1 Group, Inc., dba: ATIMS INSURER e : Ace American Insurance Conlpany 22667 <br />P.O. Box 29048 msuRER D :%ndelwriters At Lloyd's, London 15792 <br />Glendale, CA 912{j9-9{fa8 <br />INSURER E: I <br />r/11rcOAf_CC f_GRTICICATr- Ill 1URF0- ATIM9n1r,-I RFIQCIAM NIIPARFR- <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 LTR NSR TYPE OF INSURANCE D <br />OL <br />2M <br />R <br />WVD <br />POLICY NUMBER POLICY EFF POLICY w EXP <br />LIMITS <br />GENERAL LIABILITY <br />_. SSI., 4257556 a/ 1 /20 11 I 4/1,1012 :. EACH OCCURRENCE <br /> <br />____. <br />l_ $ <br /> <br />o?x){c 1 <br /> <br />A COMh1ERC1AL GENERAL LIABILITY RENTED <br />PREMISES lEa oaaxra <br />1 00 000 <br />CLAIMS-MADE OCCUR ! MED EXP (Any one person) S 55.000 <br /> <br />? PERSONAL & AM INJURY f 3,0{10,000 <br />- _. <br /> GENERAL AGGREGATE f _ 3.000,000 <br /> <br />GEKL AGGREGATE LIMIT APPLIES PER j PRODUCTS - COMPIOP AGG S 3 OI)D,OOO <br />?I. POLICY ; PRO- LOC f <br /> <br />AUTOMOBILE LIABILITY <br />B COMBINED SINGLE LIMIT <br />7318-37-62 14`P201 1 4/112012 rEaaccident) 1 .000.000 <br /> <br />-.-- <br />ff_ <br />? <br />i ANY AUTO <br />BODILY INJURY (Per person) <br />f <br /> i ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS <br />BODILY INJURY (Per accident) <br />f <br />- <br /> ( <br />?- ? 1 HIRED AUTOS ! ? NON-OYMED <br />AUTOS <br />LeOr PaDAMAGE - <br />- <br />f <br /> a <br /> '., UMBRELLA UA13 <br />-.....: ? OCCUR 024591348 4115201 1 i 4/ 1/2012 EACH OCCURRENCE f 10.000 000 <br /> <br />L- <br />A EXCESS L]AB CLAIMS-MADE ! j AGGREGATE f 10,000,000 <br /> DED RETENTIONS <br /> WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br /> <br />? WG STATU- OTH- <br />W-LRC43119606 4/1 /2011 41112012 <br /> N <br />YIN <br />ANY PROPRIETORIPARTNERJI.CU IVE <br />F-] <br />NIA <br />E.L. EACH ACCIDENT <br />- 1,000,000 <br />f <br /> OFFICERAIEMBER EXCLUDED? <br />(Mand+aory in Nl) E.L. DISEASE - EA EMPLOYE <br />-- - f 1.000,000 <br /> M es describe under <br />DESCRIPTION OF OPERATIONS below ---- <br />E.L DISEASE - POLICY LIMIT <br />f 1 ,000+000 <br />D ; Errors & Ornissions 817;2011 8;7/2012 rkc„rr « 1,000,000 <br /> AP 00039 OJ <br /> 000 <br />-.000 <br /> , <br />IPPR:12:1?C <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adaeh ACORD 101, Additional Remarks Schedule, I man apace to required) <br />City of Santa Ana, its officers, employees, agents, volunteers and renresentatives are additional insureds under the <br />General Liability policy. Primary and Non-Contributory coverage clause will apply. Separation, of Insureds clause <br />applies under the General Liability policy. Notice of cancellation ur+_de.r General Liability: 30 days r 10 days for <br />nor,-payment of premium or fraud. <br /> <br />r_r-u rrFU=ar ? 1 nFw ?r. _n i_ A-AWrcr r Arv W <br />(folder's Nature of Interest :Additional Insured-7 <br />?'' ; u i t: t :1? 511: Ci1}' <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana , i;tr:?; C=ity .?llCrt7 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 AUTNOT+QED REPRESENTATIVE <br />®1888-2010 ACORD CORPORATION. Alt" nerved. <br />ACORD 25 (2010105) The ACORD name and I o are registered marks of ACORD <br />?xhibit 1 <br />25B-25