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ClientiL: 3908 9 <br />OSTS <br /> <br />ACORO,M CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YWY) <br /> s/zz/2012 <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 farms and conditions of the policy, certain policies may require an endorsement. A statement on this eertiflcate does not confer rights to the <br />certificate holder in Ileu of such endorsement(s). <br />PRGDUGER ^ Tami Hamlin <br />NAME- <br />USI of Southern California SC PHONE 949 790-9297 484 652-5079 <br />A/C No Ext : A/C No <br />Lic # 0351162 noDRlESS: tami.hamlin@usi.biz <br />29A Technology Drive <br /> INSURERS AFFORDING COVERAGE NAIC Ir <br />Irvine, CA 92618 INSURERA: Golden Eagle Insurance Corporat 10836 <br />INSURED INSURER B: Preferred Employ@rs Ins Company 10900 <br />OSTS, Inc. INSURER c :Underwriters at Lloyd's London 15792 <br />dba: Occupational Safety <br /> INSURER D <br />14650 Central Avenue <br /> INSURER E <br />Chino, CA 91710 <br /> INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 REOUIR EM ENT, 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR TYPE OF INSURANCE AODL <br />IN R SUER <br />WVD <br />POLICY NUMBER POLICY EFF <br />MM/OD/YYYY POLICY EXP <br />MM/DD/1'YYY LIMITS <br />A GENERAL LIABILITY CBP8411963 4/17/2012 04/17/201 E <br />A <br />C <br />H <br />O <br />C C <br />URRENCE $1 OOO OOO <br /> X COMMERCIAL GENERAL LIABILITY p <br />gI <br />? <br />q? <br />E <br />T <br />PREMISES Ee occurrence $ 5OO 000 <br /> CLAIMS-MADE ? OCCUR MEO EXP (Any one person) $5 OOO <br /> PERSONAL 8 ADV INJURY $ 1 OOO OOO <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 <br /> POLICY PE ? LOC $ <br />A AUT OM061LE LIABILITY CBP8411963 4/17/2012 04/17/201 COMBINED SINGLE LIMIT <br />Ee accident <br />1,000,000 <br /> ANY AVTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED <br />BODILY INJURY (Per accident) <br />$ <br /> AUTOS AUTOS <br /> <br />X <br />X NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accitlant <br /> <br />A ?( UMBRELLA LIAR X OCCUR CU8412263 4/17/2012 04/17/201 EACH OCCURRENCE $2 OOO OOO <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $2 OOO OOO <br /> DED X RETENTION $1 OOOO $ <br />B WORKERS COMPENSATION <br />' WKN10574512 4/17/2012 04/17/201 X we sTATU- orH- <br /> AND EMPLOYERS <br />LIABILITY <br />Y / N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OOO OOO <br /> OFFIGER/MEMBER EXCLUDED? ? <br />(Mantlatory In NH) N / A <br />E.L. DISEASE - EA EMPLOYEE <br />$1 OOO OOO <br /> If yes, tleacribe untler <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$1 OOO OOO <br />C Professional 453775 8/31/2011 08/31/201 $1,000,000 <br /> Liability <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach AGORD 101, Atltlltlo 1 hadula, more apace la required) <br />? <br />d res are named additional per <br />City of Santa Ana, its officers, employees, agents,x I? <br />attached policy endorsement R <br /> <br />A?o??y <br />3?geQC ri <br />` <br />:sty° <br /> <br />CERTIFICATE HOLDER CANCELLATION <br />Cit of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />dO <br />© 7988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (201 O/OS) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S7378386/M73D3546 TJHJB