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'``moo CERTIFICATE OF LIABILITY INSiJRANCE °"TE`"IM'° ° "YYY'
<br />��- 9/17/2012
<br />THIS CERTFiCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />G ERII FICATE qO ES NOT AFFIRMATIVELY OR NEGATVELY AMEND, EXTEND VR ALTER THE COVERAGE AFFORDED BY THE' POLICIES
<br />BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEA� CGNTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER_ _ ._ .. ...... ....... .__. .
<br />IMPORTANT' If the,. cartlfleate'holder Is an- ADDITIONAL INSURED, the pofley (les) must be endorsed. 'IT SU BROGATION.I S..WAIYED,.subJect to. ,
<br />[he terms and condltloris oT the �pollcy, cartaln gdlcles may re quire an endorsement., A. statement on thl5certlflcafe does not confer rights [o the
<br />'�' certlflcate holder In Ilea of such endorsement s . - � -
<br />PRODCk_6R
<br />Erica Hornaday ,� �' ���
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<br />The Empire - Calmlpany - �
<br />550 Par7ccenter Drive �/ -�U //- /�7 DU/
<br />PHONE _..(7341 B36= 9445. N���rve .. t71U B95 99<6
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<br />- : chornada @empz.re -co _ com� -�-
<br />Soli to �2OS� -- -
<br />INSURERS AFFOJiDI1VG COVERAGE
<br />INAIC S. '
<br />Santa Ana. CA 92705 -3521
<br />INBURERA :oold,ea Ea 1e 2nsurance C n
<br />0836 -
<br />INSURED
<br />INSURERB:Hart�ord =asurance C sn oP
<br />EACH OCCURRENCE
<br />TRANS POR7ATSON STUD =ES, SNC_
<br />INSURERC:[hLi ted States Liabil it
<br />5835
<br />INSURER D :
<br />'
<br />2 64 O F7AZ.N<7T AVE STE H
<br />[snit H
<br />INSURER E
<br />TUSTSN CA 92780
<br />IN9URERF:
<br />X CLAIMS�+IPDE � OCCUR
<br />COVERAGES CERTIFICATE NUM BER:12 /13 master 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 PERXJD
<br />INDICATED. NOTWrrH STAND6JG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAW, THE INSURANCE AFFORDED BY THE POLICIES DESC RIBED`H ER EIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIq CLAIMS.
<br />ILA
<br />TYPE OF P13URANCE
<br />POLICY NUMBER
<br />POLICY F
<br />M /ODIWVY
<br />LIMITB
<br />GENERAL LIABILRV
<br />EACH OCCURRENCE
<br />S 1 , 000 , 000
<br />P ISES E o
<br />i - 50,000
<br />X COMMERCV+L GENERAL LWOILITY
<br />A
<br />X CLAIMS�+IPDE � OCCUR
<br />E7609482
<br />O/1 /2012
<br />O/ =/2013
<br />MED EXP ale arson)
<br />i 5,000
<br />PERSONAL BADV INJURY
<br />i 1,000,000
<br />GENERAL AGGREGATE -
<br />S 2 , 000 / 000
<br />GENt AG.G REGATE
<br />LMR APPLIES PER:
<br />PRODUCTS-- COMP/OP AGG
<br />i 2 , 000 , 000
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<br />X POLICY.
<br />.PRO LOC
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<br />AUTOMOBILE LViBILT'
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<br />1 OQO 000
<br />BOD)L1' NJV4i\' IPer Person)
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<br />X -� -'ANY AUTO .. .. �, .... ..
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<br />�TOB ED. .�TOEOULED
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<br />.7297043 : � - � , �,
<br />O/1�./2012
<br />O /1 /= =2013.;-
<br />BODILY NJURY (PePav:denf)'i
<br />HIRED P.UTOS AUTOS -
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<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />i 1, 000, 000
<br />AGGREGATE
<br />S 1,000,000
<br />A
<br />E%CESS LIAB
<br />CLAIMSMAOE
<br />DED RETENTION
<br />08872632
<br />0/1/2012
<br />O/1 /2013
<br />i
<br />$
<br />WORHERS COMPENSATION
<br />X WC STAT V- OTH-
<br />AND EMPLOYERS' LIABILITY Y / N
<br />E,L. EACH ACCIDENT
<br />S 1 000 000
<br />ANY PROPRIETOR /PARTNERlEXECUTIVE
<br />OFFICER/MEMBER EXCLUDF.LYI �
<br />{Mantlrtory In NH)
<br />N/A
<br />2WLrCHR7609
<br />0/1 /2°12
<br />O/1 /2013
<br />E.L. DISEASE - EA EMPLOY
<br />S 1 000 000
<br />If YYees tlesoribe ulcer
<br />DESCRIPTION OF OPERATIONS babN
<br />E L. DISEASE - POLICY LIMIT
<br />i 1 000 OOO
<br />C
<br />Errors & OLLi551 on5
<br />P1022743,1
<br />O/1 /2012
<br />0/1/2013
<br />Limr 1,000,000
<br />DetlutY'tda 1 , 000
<br />DESCRIPTION OF OPERATO NS / LOCATONS! VEHIDLES [Aaaoh ACORD'10'I, Atltlltlonal Remvke Behetlule, Ir more epees 1• r�gWretl)
<br />L2Ec On -Call tra££ic counting servioc_ Certificate Holder is additional insured as respects to general
<br />liability per £orzn 44 -148 (06/04) attaohad_ Primary and non- oontributory wording applies for general
<br />liability per £orm 44 -231 (07/10) attached_
<br />GEKIIhICA1 E HOLDER -- - "-' i v r V CANCE).�ATION
<br />� � SHOULD ANY OP THE ABOVE DEBCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXP1RATiON DATE THeRCOP, NOTICE WILL BE DELIVERED IN
<br />City o£ Santa Ana
<br />Laura 'tt Sheedy ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: sriahir Gobran Assistant City Attorney AUTTIDRIZED REPRESENTATVE
<br />20 Civic Center Plaza, M -43
<br />Santa Ana, CA 92702
<br />Larry Jonas /KATHY �� �-� "''"`' � '� "r�.
<br />ACORD 25 (2010105) O 1988 -2010 ACORD CORPORATION_ All rights reserved.
<br />1NSD25 tzoioos)oi Tho ACORD Hama and logo are registered marks of ACORD
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