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<br />A CERTIFICATE OF LIABILITY INSURANCE
<br />D /28/2013Y)
<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
<br />MOC Insurance Services
<br />License No. 0569960
<br />44 Montgomery St., 17th Fl.
<br />San Francisco CA 94104
<br />CONTACT Donna de rabic
<br />NAME
<br />PHONE (415)957 -0600 - A/0 (415)959-0597
<br />E'oIL .ddefabio @maroevich.00m
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />INSURERA:Golden Eagle Insurance Corp
<br />10836
<br />INSURED
<br />Keyser Marston Associates, Inc.
<br />55 Pacific Avenue Mall
<br />San Francisco CA 94111
<br />INSURER B:Re UbliC Indermnity Company of
<br />22179
<br />INSURER C:Evans ton Insurance Co.
<br />35376
<br />INSUaeR O:
<br />NSURER E:
<br />$ 1,000,000
<br />INSURER F:
<br />X COMMERCIAL GENERAL LIABILITY
<br />COVERAGES CERTIFICATE NUMBERMASTER 2012 -13 REVISION NUMBER:
<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 DR 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 />TR
<br />TYPE OF INSURANCE
<br />A
<br />UBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />YY
<br />POLICY EXP
<br />/DD
<br />LIMITS
<br />GENERALUABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />EACH OCCURRENCE_
<br />$ 1,000,000
<br />r
<br />Donna de Fabio /DDF �..�...J cr+M.�vrsa,.,,
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMGE( RELATE nt
<br />PREMISES T E rrer oe
<br />$ 500,000
<br />A
<br />CLAIMS -MADE � OCCUR
<br />X
<br />BP8932329
<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 Deduotible applies
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEML AGGREGATE
<br />LIMITAPPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$ 1,000,000
<br />POLICV
<br />X PRO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />E8 BIKED SINGLE LIMIT
<br />1,000,00o
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />o cY�
<br />APPROVED AS
<br />rO FOR
<br />BODILY INJURY(Psraccldent)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />A 8932429
<br />12/1/2012
<br />12/1/2013
<br />X
<br />HIRED AUTOS X NON _OWNED
<br />AUTOS
<br />PROPERTYD MMA08
<br />I
<br />$
<br />Uninsured Motorlst Combined
<br />$ 1 000 DDO
<br />X
<br />Camp $500 X Coll $600
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />�-
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />DGE
<br />It O.H
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />.
<br />AGGREGATE
<br />$ 4,000,000
<br />X
<br />�pe
<br />O 893262 y
<br />�Lke racov
<br />IMA9MI
<br />12/1/2D13
<br />LED X RETENTION$ 510,000
<br />I
<br />$
<br />WORKERS COMPENSATION
<br />X WCSTATU- OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />$ 1 ODO 000
<br />ANY PROPRIETOR/ PARTNER /EXECUTIVE
<br />1—C
<br />OFFICER /MEMBER EXCLUDED? ❑
<br />(Mandatory In NH)
<br />NIA
<br />03954618
<br />12/1/2012
<br />12/1/2019
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />EL DISEASE - POLICY LIMIT
<br />$ 1 00D 000
<br />Professional Liability
<br />0- 852080
<br />12f1/201.3
<br />Each Wrongful Act $1,000,000
<br />Retention: $50,000
<br />etro Data 11/7.1/1976
<br />F12/1/2012
<br />AGGREGATELIMIT $2,000,000
<br />DESCRIPTION OFOPERATIONS 1 LOCATIONS I 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 with
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any
<br />other insurance carried. 30 Day Notice of Cancellation /10 Day for nonpayment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 26 (2010/06)
<br />INS 025 (2010D5) at
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE
<br />WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />Executive Director of PEA
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />r
<br />Donna de Fabio /DDF �..�...J cr+M.�vrsa,.,,
<br />ACORD 26 (2010/06)
<br />INS 025 (2010D5) at
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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