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<br />CERTIFICATE OF LIABILITY INSURANCE AT E
<br />P 06M SDOD2YYY)
<br />
<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 endorsement(s).
<br />PRODUCER CONTACT
<br />AOn Risk Services Northeast
<br />Inc NAME:
<br />,
<br />.
<br />New York NY Office PHO
<br />[A/C.NNo. Ext): (866) 283-7122 F'O`X (847) 953-5390
<br />AIC. No.):
<br />199 water Street E-MAIL
<br />New York NY 10038-3551 USA ADDRESS:
<br /> INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />ICF
<br />&
<br />k INSURER A: AXIS Surplus Insurance Company 26620
<br />Jones
<br />sto
<br />es, Inc.
<br />9300 Lee Highway INSURER B: Federal Insurance Company 20281
<br />Fairfax VA 22031-1207 USA INSURER C: Great Northern Insurance Co. 20303
<br /> INSURER D: Sentry Ins A Mutual Company 24988
<br /> INSURER E:
<br /> INSURER F:
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<br />a Uvr_rv4VCa I.tKIIrIGAIt NUMt3tK: 570046t64UJU 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 />,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />. Limits shown are as requested
<br />LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDNYYY) MM, CY EYY LIMITS
<br />C GENERAL LIABILITY 35812409
<br />Pack
<br />- D
<br />i Ub/25/ZUIZ U6/25/2013 EACH OCCURRENCE $1,000,000
<br />
<br />COMMERCIAL GENERAL LIABILITY age
<br />omest
<br />c DAMAGE TO RENTED $1
<br />000
<br />000
<br /> A Y ` PREMISES Ea occurrence ,
<br />,
<br /> CLAIMS-MADE X? OCCUR 0 AS
<br />PIM M
<br />R
<br /> 1 1 MED EXP (Any one person) $10,000
<br /> X Prod-Comp Op Incl in Gen'I Agg PERSONAL & ADV INJURY $1, 000, 000
<br /> X
<br />Contractual Liability
<br />GENERAL AGGREGATE
<br />$2,000,10 0
<br /> GEN'L AGGREGATE LIMIT APPLIES PER.
<br />'RO
<br />VVV
<br />( PRODUCTS - COMP/OP AGG cnD
<br /> T LOC
<br />X POLICY _ _ _ o
<br />C AUTOMOBILE LIABILITY 73522955 6 25/2013 COMBINED SINGLE LIMIT 'n
<br /> Automobile -AiI
<br />4 ?I
<br />L
<br />U Ea accident $1,000,000
<br /> iI ,
<br />q
<br />I
<br />M ley
<br /> X ANY AUTO BODILY INJURY ( Per person) O
<br />Z
<br /> ALL OWNED SCHEDULED BODILY INJURY (Per accident)
<br /> AUTOS AUTOS
<br />N
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE U
<br /> AUTOS (Per accident)
<br />
<br />B X UMBRELLA LIAB
<br />I X
<br />-
<br />I OCCUR 93630018
<br />
<br />umbrella Li
<br />bilit 06/25/2012 06/25/2013 EACH OCCURRENCE $5,000,000 U
<br /> ?
<br />EXCESS LIAR I CLAIMS-MADE a
<br />y
<br />SIR applies
<br />per policy ter
<br />
<br />ns & condi
<br />
<br />ions AGGREGATE $5,000,000
<br /> DED X RETENTION
<br />D WORKERS COMPENSATION AND
<br />' 90-17657-01 06/25/2012 06 25/2013 WC SMATU- OTH-
<br />X
<br /> EMPLOYERS
<br />LIABILITY
<br />YIN
<br />workers comp TORY LIMITS ER
<br />D ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED'
<br />NIA
<br />90-17657-02
<br />06/25/2012
<br />06/25/2013 E. L. EACH ACCIDENT $1,000,000
<br /> NH)
<br />M, describe in
<br />yeses, describe under Workers Comp E.L. DISEASE-EA EMPLOYEE $1,000,000
<br /> D
<br />
<br />DE
<br />SCRIPTION OF
<br />OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,00
<br />0
<br />A E&O-MPL-Primary EBZ 768043/01/2012 06/25/2012 06/25/2013 Prof Liab Agg - All $3,000,000
<br /> Errors & Omissions overall policy aggr, $3,000,000
<br /> -
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re: On-Call Services. The City of Santa Ana, its officers, agents, employees, volunteers and reppresentatives are included as
<br />Additional Insured as res
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<br />ty, as required by written contract. If required by insured contract, such
<br />insurance as is afford
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<br />mary and no other insurance of the Additional Insured will be called upon to
<br />contribute to a loss.
<br /> JA
<br />
<br />CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EX
<br /> PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS.
<br />f
<br />City o
<br />Santa Ana
<br />20 Civic center PlaZa, ROSS Annex M-20 AUTHORIZED REPRESENTATIVE
<br />P.U. Box 1988
<br />
<br />Planning and Building Agency
<br />Santa Ana CA 92702 USA ?Q ?i
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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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