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ACURtf CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDNYYY) <br />k.� <br />04/18/2012 <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(3), 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 <br />WELLS FARGO INS. SERV. USA -CH, NC <br />_CONTACT <br />6100 FAIRVIEW ROAD, SUITE 800 <br />PO BOX 220748 <br />PHONE xt ; FA < No): <br />E-MAIL DRESS <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />CHARLOTTE, NC 28222 <br />INSURER A: TWIN CITY FIRE INSURANCE CO. <br />INSURED 5313 - AZ <br />INSURER B: <br />INSURER C: <br />STRATEGIC OUTSOURCING, INC. <br />INSURER D: <br />PO BOX 241448 <br />INSURER E: <br />CHARLOTTE, NC 28224 <br />INSURER F: <br />MF <br />DAEAGSE T ERE TED $ <br />COVERAGES CERTIFICATE NUMRER. 46.002 I011=11MI I Ku I1111Cco. <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 />ILTRNSR <br />TYPE OF INSURANCE <br />D ' <br />NNo POLICY <br />NUMBER <br />POLICY EFF <br />NPIOLICCY EXP IDONMI <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE ❑ OCCUR <br />MF <br />DAEAGSE T ERE TED $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />POLICY PRO LOC <br />$ <br />AUTOMOBILE LIABILITY <br />CO(EaMBINED Accdent,SINGLE LIMIT $ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />(Peraccident) $ <br />b45904 <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAB <br />CLAIMS MADE <br />AGGREGATE $ <br />DED I RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATIONX <br />AND EMPLOYERS' LIABILITY Y!N <br />ANY PROPRIETOR/PXCLUDED? /EXECUTIVE� <br />OFFICER/MEMBER EXCLUDE <br />(Mandatory In NH) <br />If yes, describe under <br />N/A <br />22WBRG30096 <br />03/01/2012 <br />03/01/2013 <br />WC STATU- OTH- <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,600 <br />E.L. DISEASE - POLICY LIMIT $ 1,500,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES (Attach 107, Additional Remarks Schedule, If more space Is required) <br />LIMITED TO THE EMPLOYEES LEASED TO SIGNt V7119f11NOLOY qWUJ?C"Y STRATEGIC OUTSOURCING, INC. <br />FAX: 602-443-8086 <br />Laura Stat S}lcedy <br />Assistant City Attorn <br />CITY OF SANTA ANA <br />ATTN: LINDA KELLY <br />20 CIVIC CENTER PLAZA M-1 <br />SANT ANA, CA 92701 <br />ss..L-A c <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />U 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />