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12 Fox LTR <br />144C11GO,RLY CERTIFICATE OF LIABILITY INSURANCE <br />DAT04/18D/YYYY) <br />F 04/18/12 <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(les) 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 480-820-4040 <br />Webb & Greer Ins Agency, Inc. 480-730-1191 <br />301 W Warner Rd #113 <br />Tempe, AZ 85284 <br />Jeremy P. Grohman, CIC <br />NCNTACT <br />AME: <br />PHONE FAX <br />A/c No Ext): NC,No): <br />E-MAIL <br />PRODUCER <br />CUSTOMER ID #: SIGNA-3 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Signature Technology Group Inc <br />11265 Sunrise Gold Circle <br />Rancho Cordova, CA 95742 <br />INSURER A: Massachusetts Bay Ins Co. 22306 <br />INSURER B:Allmerica Financial Benefits 41840 <br />INSURER C : <br />INSURER D: <br />INSURER E: <br />INSURER F: <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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRADDLISUBl <br />LTR <br />TYPE OF INSURANCE <br />INSR <br />VJVQ <br />POLICY NUMBER <br />PO CY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MMIDD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />X <br />AW4941575700 <br />01/01/12 <br />01/01/13 <br />PREMISES Ea occurrence $ 300,00 <br />CLAIMS -MADE Fx_] OCCUR <br />MED EXP (Any one person) $ 5,00 <br />&ADV INJURY $ 1,000,00 <br />-PERSONAL <br />GENERAL AGGREGATE $ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 2,000,00 <br />X POLICY PRO - <br />FLOC <br />I <br />I <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,00 <br />B <br />X <br />ANY AUTO <br />OD4941575900 <br />01/01/12 <br />01/01!13 <br />(Ea accident) <br />BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) $ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />$ <br />$ <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 5;000,00 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />W4941575700 <br />01/01/12 <br />01/01/13 <br />AGGREGATE $ 5,000,00 <br />DEDUCTIBLE <br />F <br />$ <br />RETENTION $ 5000 <br />WORKERS COMPENSATION <br />$ <br />WC STATU- OTH- <br />AND EMPLOYERS' LIABILITY Y / NTCRY <br />E.L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? r7 <br />N / A <br />(Mandatory In <br />If yes, describe under nd <br />E.L. DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />City of Santa Ana, Its officers employees, agents, volunteers and <br />representatives are additional insured for general liability per 391-1006 <br />06/09. Coverage Is primary & non-contributory 391-133106109. <br />per Waiver of <br />Subrogation applies to general liability per BP0497. <br />CITYS64 <br />City of Santa Ana APPROVED AS TO <br />Attn: Lynda Kelly <br />20 Civic Center Plaza M-12 <br />Santa Ana, CA 92701 � <br />La Stitt Sheed <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />"tqWDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />(719RR-2An9 ACr1Rr1 CnRPn0ATInIJ <br />ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD <br />