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�`� °® CERTIFICATE OF LIABILITY INSURANCE
<br />1/28/201Y3
<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
<br />MOC Insurance Services
<br />License No. 0589960
<br />44 Montgomery St., 17th Fl.
<br />San Francisco CA 94104
<br />CONTACT Donna de Fabio
<br />NAME:
<br />PHONE (415) 957 -0600 FAX Not: (415)957 -0577
<br />E-MAIL .ddefabio @maroevich.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA-.Golden Eagle Insurance Corp
<br />10636
<br />INSURED
<br />Keyser Marston Associates, Inc.
<br />55 Pacific Avenue Mall
<br />San Francisco CA 94111
<br />INSURER B :Re ublic Indemnity Company Of
<br />22179
<br />INSURER C -Evanston Insurance Co.
<br />35376
<br />INSURER D:
<br />INSURER E:
<br />$ 1,000,000
<br />INSURER F:
<br />X COMMERCIAL GENERAL LIABILITY
<br />COVFRAnPR CFRTIFICATF NIIMRFR•MASTER 2012 -13 RFVI -glnN NI IMRFR-
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIODIYYY
<br />POLICY EXP
<br />MM /DD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />TO RENTE5--
<br />PREMISES Ea occurrence
<br />$ 500,000
<br />A
<br />CLAIMS -MADE F—x1 OCCUR
<br />X
<br />CBPO932329
<br />12/1/2012
<br />12/1/2013
<br />MED EXP (Any one person)
<br />$ 10, 000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />O Deductible applies
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GE,' L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$ 1,000,000
<br />POLICY X PRO-
<br />JFCT F-1 LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED B' nt N LELIMIT
<br />11000,000
<br />x
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />BA 8932429
<br />12/1/2012
<br />12/1/2013
<br />X
<br />PROPERTY DAMAGE
<br />P r c ident
<br />$
<br />HIRED AUTO S X NON -OWNED
<br />AUTOS
<br />X
<br />Uninsured Motorist Combined
<br />$ 1,000,000
<br />Camp $500 X Coll $500
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION$ $10,000
<br />$
<br />X
<br />I
<br />CU 8932629
<br />12/1/2012
<br />12/1/2013
<br />$
<br />WORKERS COMPENSATION
<br />X WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />ANY PROPRIETOR/PARTNER /EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />N/A
<br />03954618
<br />12/1/2012
<br />12/1/2013
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />Professional Liability
<br />0- 852080
<br />12/1/2012
<br />12/1/2013
<br />Each Wrongfull Act $1,000,000
<br />Retention: $50,000
<br />Retro Date 11/11/1976
<br />AGGREGATE LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and /or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured wi
<br />i
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory wit (5n
<br />other insurance carried. 30 Day Notice of Cancellation /10 Day for nonpayment of premium.9 AS
<br />v �QR v
<br />VCM I Irl"M 1 C n%JL.UClrt L ANL rLLA I IUN l Z/VJ" -� \tiYl r
<br />City of Santa Ana
<br />Executive Director of P13A
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POL100-23'6E CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />de Fabio/DDF -, C,,+vvw....+ c,
<br />AUUKU ZO (ZUTUIUb) U 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />INS026 (201005).01 The ACORD name and logo are registered marks of ACORD
<br />1
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