|
ACORO®
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YVYV)
<br />�� O4/ 1 6/201 2
<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 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 NAMEACT Chanel Popadiuk ____
<br />0o ru - Sawyer 8c Co. PIioN1= - 949 - 435 -7361 I jnic Nom__ 949 476 -3 1 18
<br />(A /C. No. EatY _____
<br />2 Park Plaza, Suite 500 E -MAIL � - -- - �- - - -- - --
<br />Irvine, CA 92614 ADDRESS: epopadiuk n,wsandco.com __ _ __ __ _
<br />(888) 646 -9636 INSURERS) AFFORDING COVERAGE _ _ ___ NAIC # _ __
<br />- _ _ ____ INSURER A : Federal Insurance Com an 2028 )
<br />INSURED - ._.._ -._ -_ -- _ .. .._
<br />Active Network, Inc INSURER B : Travelers Property Casualty Company of Am 25674 _
<br />--
<br />t Ol 82 Telesis Ct., Suite 300 INSURER c : Chartis S ecialt Insurance Compaq___.___ 26883
<br />San Diego, CA 92 1 2 1 -4777 INSURER D : _
<br />INSURER E - -� -- ��- � -�- ��
<br />COVE -AAr FR CFRTIFIC ATF NI IMt3CO-
<br />DC \ /�C, / \�, �
<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 />INSR TYPE OF INSURANCE � ADDL SUER -- - - --
<br />POLICY EFF POLICY EXP
<br />LTR POLICY NUMBER MM /DD /YYYY MM /DD /YYYY LIMIT$
<br />A
<br />_GENERAL LIABILITY
<br />35877916
<br />04/16/2012
<br />04/16/2013
<br />EACH OCCURRENCE
<br />$ 1 >OOO >OOO
<br />X COMMERCIAL GENERAL LIABILITY
<br />_
<br />DAMA�b 2�ENTED
<br />$ 1 000,000
<br />� CX�
<br />_PREMI_SE_S_�a o c rr_e_nce)
<br />-
<br />_ CLAIMS -MADE OCCUR
<br />MED EXP (Any one person)
<br />$ 1 0,000
<br />- _ -_ _ ..... -. __ _ -- -_ -- ._.... ____- - __
<br />PERSONAL 8 ADV INJURY �
<br />$ 1 ,000,000
<br />--
<br />_ _-- .._._ -- ___.___ -_ - -_
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER'
<br />_.- - _
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000 OOO
<br />I , PRO- .' --
<br />- - _.
<br />- z.
<br />POLICY LOG
<br />$__
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />73546685
<br />04/ 1 6/201 2
<br />p4/ 1 6/2013
<br />COMBINED SINGLE LIMIT
<br />_(Ea acotlentJ__ ______ _,,,
<br />1 ,000,000
<br />b _ _-
<br />%{
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accitlon[ �
<br />_,_.
<br />AUTOS ____ -__ AUTOS
<br />$
<br />NON -OWNED
<br />HIREDAUTOS AUTOS
<br />_ __ �� � -- -
<br />$
<br />PROPERTY DAMAGE
<br />Pe ecc deny_
<br />A
<br />�{
<br />UMBRELLA LIAB
<br />�{
<br />OCCUR
<br />79865288
<br />04/16/2012
<br />04/16/2013
<br />EACH OCCURRENCE
<br />$ 12 >OOO,OOO
<br />_..._ -- _
<br />_
<br />AGGREGATE
<br />EXCESS LIAB
<br />_
<br />CLAIMS -MADE
<br />$__
<br />DED RETENTION$
<br />_ -_
<br />___12z000,O00
<br />g
<br />B
<br />WORKERS COMPENSATION
<br />WC STATU- OTH-
<br />X- I9J3YLIMITS _. _ER__..
<br />AND EMPLOYERS'LIABILITY Y/N
<br />UB3881N74612
<br />04/16/2012
<br />04/16/2013
<br />.... -.._- _ _
<br />EL EA_C_H_ACCIDE_NT
<br />ANY PROPRIETOR/PARTNE WEXEC VTIVE
<br />$ 1,000,000
<br />OFFIGER/MEMBER EXCLU DED4 �
<br />N / A
<br />- _. -
<br />(Mantlatory In NH)
<br />F L DISEASE FA EMPLOYEE
<br />$ 1_,000,000
<br />�I yes, DCSCriDO nlltler
<br />DESCRIPTION OF OPERATIONS below
<br />'- -
<br />E.L. DISEASE - POLICY LIMrI
<br />-
<br />$ I >OOO,OOO
<br />C
<br />Errors 8z Omissions
<br />0]8157431
<br />04/16/2012
<br />04/16/2013
<br />Limit $10,000,000 /SIR $]00,000
<br />Retroactive Datc: 07/ 10/03
<br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (Attach ACORD 101. Additional Remarks Schetlule, It more space is requiretl)
<br />City of Santa Ana Parks, Recreation and Community Services Agency, its officers, agents and employees are included as additional insured as rcyuired by
<br />written contract or agreement. Coverage is primary and non - contributory. See attached separation of insured's clause -form #80 -02 -2000.
<br />APPROVED AS TO FORM
<br />qYY V �� f �..
<br />. _
<br />�.crctlr tas+lc nvt_ucrc _ ---- -- - -- - ---- G- ANGELLATION
<br />City Of Santa Aria `� ^- '�'I�• � � � ^- -' +' f`` -! I �? r��i � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Parks, Recreation and Community Services Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attention: Silvia Cuevas
<br />26 Civic Center Plaza
<br />Slanta AnaL�,q� X2701
<br />ID #: c1a' --7 i� j
<br />ACORD 25 (2070/05)
<br />AUTHORIZED REPRESENTATIVE
<br />© 1988 -20'10 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|