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'`'?°RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM(YY) 9/7/2012 5/8/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcate holder IB an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and eondltlons of the policy, certain pollcles may require an endorsement. A statement on this certlflcate does not confer rights to the _ certlflcate holder In Ileu of such endorsement(s). PRODUCER Lockton Insurance Brokers, LLC NAM - License #OF15767 PHONE XCCULIVe S u S it 600 A/C No q are, u e EaYlA1L La Jolla CA 92037 ADDRESS: (HSS) S$7-31 OO INSURERS AFFORDING COVERAGE NAIC # INSURER A : N8V1 ators S ecial Insurance Com an 36056 INSURED Tech M3, Inc. dba PureForge 1344436 INSURER B 1281 Activi Drive tY INSURER C Vista CA 92081 ,?,e„_?_ _ - COVERAGES TECM301 U2 CERTIFICATE NUMl3ERe 1 1 7973fi4 _ oevlcl?u w lue?o. vvvvvvv THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD SUBR POLICY NUMBER MM?DY/WYY MM/ UY/YYYY LIMITS A GE NERAL LIABILITY Y N CEl1CGL078601IC 9/7/2011 9/7/2012 MMERCIAL GENERA?ABILITY I I DAMAGE TO RENTED PREMISES Ea occurrence $ 1 ?0 0?? CLAIMS-MADE OCCUR I _X_ I MED EXP An one rson X SIR: 2 SOO , PERSONAL 8 ADV INJURY $ j ??? 0?0 ? GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG X POLICY PRO LOC $ AUT OMOBILE LIABILITY NOT APPLICABLE (Ea accitlen[) $ ANY AUTO BODILY INJURY (Par parson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Par eccitlan[ HIRED AUTOS AUTOSWNED PROPERTY DAMAGE $ XXXXXXX $ XXXXXXX B X UMBRELLA LIAR }[ OCCUR N N 0004993 SO 9/7/2011 9/']/2012 EACH OCCURRENCE $ rj OQO 000 EXCESS LU\B CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION NOT APPLICABLE - AND EMPLOYERS' LIABILITY ,. / N TORY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXGLUDED"l ? N / A E.L. EACH ACCIDENT $ (Mandatory In NH) If as tlasmba untler E.L. DISEASE - EA EMPLOYE $ }[J{}[XXXX , DE CRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATONS /VEHICLES (Attach ACORD '101, Additional Ramartra Schedule If q1 a pace la required) City of Santa Ana is named as additional insured as per the at[achediarraer e do ce>?IeS?E('I?is{4fSais primary and non-contributory and includes a 30-day ? ? ? notice of cancellation as rZlJ ? ? er attached carrier endorsements p . d ? - y a St, (t ShCC •,,Ur • rnt City Attorney SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 '1797364 City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 ?`?' ?-?-