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? L7 ---, ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D 012 o1 02113/2 F THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Insurance Services West, Inc. PHONE (847) 953-5390 (866) 283-7122 ja Los Angeles CA office Ext): (AI C. No.): 707 Wilshire Boulevard E-MAIL Suite 2600 ADDRESS: LOS Angeles CA 90017-0460 USA INSURER(S) AFFORDING COVERAGE NAIC III INSURED INSURER A: Federal Insurance Company 20281 Tiburon, Inc. 6200 Stonerid e Mall INSURER B: Great Northern Insurance Co. 20303 g Pleasanton CA 94588 USA INSURER C: Pacific Indemnity Co 20346 INSURER D: Continental Casualty Company 20443 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570045268913 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD (MWDDNYYY) LIMITS A GENERAL LIABILITY 35911023 0970-L72U11 ZT77r7= EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED P REMISES Ea occurrence $1, 000' 000 CLAIMS-MADE X? OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO X LOC JECT B AUTOMOBILE LIABILITY 73558729 09/01/70-1-1 09/01/2012 COMBINED SINGLE LIMIT $1 000 000 Ea accident , , X ANY AUTO BODILY INJURY ( Per person) ALL OW NED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident D X UMBRELLA LIAB X OCCUR L4030957581 09/01/2011 09/01/2012 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION AMOY" TO LC -,i C WORKERS COMPENSATION AND 717397 1 09/01 2012 X WC STATU- OTH- EMPLOYERS' LIABILITY Y! N TORY LIMITS ER ANY PROPRIETOR / PARTNER! EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) If es describe under E.L. DISEASE-EA EMPLOYEE $1,000,000 y , DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 .. L:KIJST RITE Deputy Clty Atto y DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Santa Ana AUTHORIZED REPRESENTATIVE Attn: Lori Smith 20 Civic Center Plaza Santa Ana CA 92701 USA 14 MdKI-4 yc?m xJ111 d w c m a `m O 2 co m N a O n O Z (D 10 IN w d L) ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD