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<br />q???? <br />l?IV [Jj'CL.(? ?]?iO????6W? 1 ? ?? f <br />?6'@E7H ?l? r ????1?9?.??? <br />fe DATE CR11.1lDDrv YYY) <br />w <br />e. _ __ 07/31/2012 <br />THIS CERTIFICATE IS' ISSVEO AS A MATTER OF INFORR9ATION ONLY AND CONFERS NO RIGIfYS UPON YHE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRPAATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TF1E POLICIES <br />BELOW. THIS CERTIFICATE Or INSURANCE DOES NOT CONSTIYUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR FRODUC ER, AND THE CERTIFICATE HOLDER. - <br />1NAPORYANT; Kthe cor[Ificate holdor Is art ADDITIONAL INSURED, thB pollcy(IBS) must be endorsed. If SUI3ROGAYION IS WAIVED, suLiject to <br />t7]e terms and conditions of the policy, certain policies may require an endars cement. A stafemont on this certlfioate does not confer rights to the <br />certiHcata ho Wer in lieu of such endorsem ent(s}. __,? _ _ <br />PRODUCER <br />NaMEI <br />VGh) Insurance Services a? <br />?u ,Ne):319.235.6656 <br />3 <br />6Z.33&3 <br />, e.Il: SQO. <br />PO BOX 13Z$ ? <br />__ <br />__ <br />___ __ <br />ADORE <br />2111 W. San htarnan Dri Ve -YliooucER <br />MlaterlOO, IA SO7O4 <br />__. _.. ...._._____. --__--. -_ -__.-.- <br />_ NA1Cp <br />_ _ INSURER(5]AFFORUINO COVERAOC-- ____ _______ <br />? <br />R)9URED nal 3nsur-ancE: Co <br />w3URERAC .1'?tate Na'fcib <br />? - <br />Americare Ros Irator Services Inc <br />p Y w9URER B <br />- <br />- ? --?- - <br />------? ? ? ?" ?----- <br />1924 E Deere Ave Ste 110 -_ <br />---?? <br />? <br />- <br />INSU RE R C <br />--. ._.. ------- ? -??-- <br />Santa Ana, CA 92705 IN$uRER D: <br /> wsurseRE:_____ ___ <br />I wOURER F: ___ <br />COVERAGES ? CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS {S 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVF_ BEEN ISSUED TO THE INSURED NAP,IEO ABOVE FOR T HC- POLICY PERI00 <br />INDICATED_ NOTWITHSTANDING AN'r REQUIRF_tAE NT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT IMTH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR PRAY PF RTAI N, Z"HE INSURANCE AFFORDED 6Y THE PO L!C IES DESCRIBED HEREIN IS SU BJEGT TO ALL THE TERMS. <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LI MI'fS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IM$R --'- ? ??' "-'--- O r?-- -- ---'-- PISLICY EPF -??PGLI EX ? LIR11T9 <br />L_TR TYPE OF INBIffiANCE INSRI?Wn' POLICY NUMBER i MELDDRYY MSVODlYY W? <br />GENERAL LIABILITY VGPnD1011 G1324-80fll08J2012 O9IO BI2Ot3 EACH O[GCVRRENCE ?$ 1, ODD,OOD <br />1 CC+MhtERCNL GENERAL DAHILITV I ? ?1? gAtel = 5 lOO , OOD <br />X <br />-1 <br />I ) DLAIMS-MADE [ X } OCCUR I MED EXP (Any ore penun) ' S S , OOO <br />A X rof Liability ? I PERSONAL 3 ADV INJURY. - $ L r OOO `GOO <br />I `GENERAL AGGREGATE ' E Z 000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: I j ? PRODUCTS - COMPfgP AGG $ Z r OOO ?OOO <br />?-?-_ <br />? <br />_ <br />S <br />-??? POLICY PE COT 1 I LOC _ _____ _ __ ? ___ - <br />- <br />AUTOM001LE LIa BRJTY ? <br />_ I <br />j 'COMBINED SINGLE lI A(IT <br />(Ea arsitlenl) S <br />ANV AVTO I I -- ? -?--- ---`--- <br />DODIIV INJURY [Pcr person) S <br />. ALL OW NED AUTOS - -?-- --- --- ---? ----- <br />UOOILY wJURY (Per arrltlant) 3 <br />- SC HEDULED AUTOS ? ?? <br />PROPERTY DAMAGE S <br />HIRED AVTOS - i (Per erslOenl] _ <br />? <br />• ? i NONAWNED AUTOS j ? _, _ - _ S -_ - <br />- _ _ <br />i _ . S <br />UMBRELLA VAB OCCVR ?j ?- I ? -EACH OCCURRENCE S _ _ <br />_-.--XCE'SS LIAB CLAIMS?.fADB! AGGREGATE _ _ S_-_ __,-_,_ <br /> <br />__ ' RETENTION $ _____ <br />WORKERS COM PEN9AilON <br />AND EMPLOY ERB'i1A610TY Y+N ? <br />-_-? <br />? <br />? 3 - <br />WOJ1Y 4?TU- OETH? <br /> <br />3 <br />ANY PROPRIETOR/PARTN F_R/EXECUTNEr <br />1 - _ _ - <br />E.L. EACH AC CIOE NT <br />OFFICERRdL-MHER EXCLV DED? LTI NfA': <br />(M <br />antlatory In NH) - <br />EL. OfSEASE _ FA EMPLOYEE S <br />I <br />yy <br />OESGRIPTIO OF OPERAT?INS axlvv _ _ ____ <br />- __-_ <br />EL OlSEASE -POLICY LIIAIT S <br />--o?lE'D AS `? `_ <br />/, <br />i ----- y ? <br />- ?`-?--?/ <br />??? <br />DESCRIPTION OF OPERATIONS l LOCATIONS J VF.IfICLE4 (AUACh ACORO IQt, AdtllUOna1 Remarf:e Schetlule, <br />0-0029841 Ir mara apace la reQUlretl) `-? . ? :./' <br />? <br />? <br />K <br /> _?- ,. <br />C <br />ST OR <br />l <br /> ?, <br />r <br />t.1SA <br />C1ty Attorney <br /> t <br />tan <br /> sls <br /> <br />LitK I IFII+H 1 i= r'IVLUCK <br />r___^- <br />SHOULD ANY OF THE A60VE OFSCRIB ED POLICIES BE CAHC ELLE6 BEFORE <br />' THE EXPIRATION DATE THEREOF, NOTICE WILL BE OC•LIVERER fN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana -- <br />Purchasinc? Dept AUTHORIZED REPRESENTATR/E ?\Q?M <br />70 Civic Center Plaza <br />Santa Arta, CA 92701 ^_ ;Jason 8ienernannf-1A50NB <br />Cam] 7988-2009 ACORD CORPORATION. Ali rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />Exhibit C