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<br />ACORO®
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /DD /YYYY)
<br />07/0312012
<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 INSU E„ QIOE,,S OT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, ANME-AdERT}#IAll -POFp
<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 policyCzWrtam policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endo ,ffierlt(s).
<br />PRODUCER;
<br />Aon Risk Services Central, Inc. - ',°
<br />Pittsburgh PA Office
<br />CONTACT
<br />NAME.
<br />PHONE (866) (666) 283 -7122 (A/C. No.):
<br />(847) 953 -5390
<br />E-MAIL
<br />ADDRESS:
<br />Dominion Tower, 10th Floor
<br />625 Liberty Avenue
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Pittsburgh PA 15222 -3110 USA
<br />INSURED
<br />INSURER A: Liberty Mutual Fire Ins Co
<br />23035
<br />RBF Consulting
<br />PO BOX 57057
<br />Irvine CA 92619 -7057 USA
<br />INSURER B: Liberty Insurance Corporation
<br />42404
<br />INSURER C: Lloyds syndicate No. 2623
<br />1128623
<br />INSURER D:
<br />INSURER E:
<br />S1,000,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570046975652 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. Limits shown are as requested
<br />INSR LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />MM/DD
<br />MM/DD
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />TB2681004145712
<br />Ub1301Z01Z
<br />D67307=
<br />EACH OCCURRENCE
<br />$2,000,000
<br />• COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence)
<br />S1,000,000
<br />CLAIMS -MADE X❑ OCCUR
<br />MED EXP (Any one person)
<br />$5,000
<br />• Contractual
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />•
<br />BFPD,XCU
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$4,000,000
<br />POLICY X PRO X LOC
<br />JECT
<br />A
<br />AUTOMOBILE LIABILITY
<br />As2 -681 -0041
<br />2013
<br />COMBINED SINGLE LIMIT
<br />Ea ccident
<br />$1,000,000
<br />BODILY RY (Per person)
<br />ANY AUTO
<br />tr
<br />1
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X -OWNED
<br />AUTOS
<br />Ix
<br />/ ( 1
<br />(NON
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Per accident
<br />HODG
<br />•
<br />X
<br />UMBRELLA LIAS
<br />X
<br />OCCUR
<br />TH768100414568
<br />/
<br />/30/2013
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />J
<br />AGGREGATE
<br />$10,000,000
<br />DED RETENTION E10, 000
<br />•
<br />•
<br />WORKERS COMPENSATION AND
<br />YIN EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />OFF ICER/MEMBEREXCLUDED? �
<br />NIA
<br />WA768DO04145692
<br />ADS
<br />WC7681004145702
<br />06/30/2012
<br />06/30/2012
<br />06/30/2013
<br />06/30/2013
<br />X WC STATU- - H-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,6-0-0
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />wi
<br />E.L. DISEASE- POLICY LIMIT
<br />$1,600,660
<br />C
<br />E&O -PL- Primary
<br />ti
<br />QC1202675
<br />06/30/2012106/30/20131
<br />Per Claim
<br />$5,000,000
<br />Professional & Pollution
<br />Aggregate
<br />$5,000,000
<br />SIR applies per policy terns
<br />& condi fions
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Project: 3N10- 108391, Mater Dei High school Parking Structure.
<br />City of Santa Ana, its officers, agents, volunteers, employees and representatives are included as Additional Insured on the
<br />General Liability policy as required by written contract. Coverage afforded under the General Liability policy is Primary.
<br />Separation of Insured clause applies under the General Liability policy. Form LIM99010511 - Notice of Cancellation to Third
<br />Parties - 30 day is attached to the General Liability policy.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana AUTHORIZED REPRESENTATIVE
<br />c/o Clerk of the Council
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Santa Ana CA 92702 USA
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<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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