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.wcoR CERTIFICATE OF LIABILITY INSURANCE DATE (MMlOD/Yl'Yl7
<br />1 2/1 8/2012
<br />THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E%TEND^f Obi ALYE�t LTHE'(30y�R./��gE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTfFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 'BETWEEN YHE 153UING INSURPR(S), AUTIiORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER_
<br />IMPORTANT: I# the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. IL�OGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsernent_ A staterne�t on thf6r cafe does not confer rights To the
<br />cer[Iflcate holder in lieu of such endorsements _
<br />PRODUCER co TOM PODEG RACZ
<br />NAME:
<br />PODEGRACZ INSURANCE AGENCY 'PHONE .310 374 8_011 _ L��,NO)_310 374 5321
<br />116 S CATALINA # 11 O wnoRl�sa_TOM @TOMINSURE.COM ___ __ _ _
<br />LIC #0812544 �I /� �O /� _ J __INSURER S)AFFORDING GOYERAGE _- _ NAIC Y
<br />REDON DO 9EACH, CA 90277 ,(/ INauRERA: COLONY INSURANCE COMPANY A X11
<br />INSURED -- -- -.. - -.. ___ —.
<br />INSURERe:ADMIRAL INSURANCE COMPANY I
<br />BEAVENS SYSTEMS, INC. wsuRERC:TRUCK INSURANCE EXCHANGE _ __ � _ _
<br />2200 PACIFIC COAST HWY #307 wsuRER O: FARMERS INSURANCE EXCHANGE
<br />_. _--
<br />HERMOSA BEACH, CA 90254 flusuRERE: ___ _ __ _.. .,_ _ _ __ _ _
<br />INSURER F:
<br />Rr'1V FQ A2 F4 rc OTl rlrwry wll use Ce. eevrc rA w, oases ee.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF IN SL RAN CE LISTED BELOW HAVE BEEN ISSUED TO 7HE 1NSU RED 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 CONOfTfO NS OF SUCH POLICIES. LfMfTS SHOWN MAY HAVE BEEN REDIK ED BY PAID CLAIMS.
<br />_ _ _
<br />INSIi TYPE OF IN30RANCE SUBR" —� - - -- �- -POLICY EFF � POLICY p[PI � LIMAS ��
<br />LTR POLICY NUNBER / MMlD
<br />A GENERAL LIABWTY X - GL953696
<br />X � COMMERCIAL GENERAL LIABILITY
<br />_ -_ I �
<br />J CLAIMS -MADE X _ OCCUR I j
<br />09/2512012109/25
<br />/2013
<br />EACH OCCURRENCE __
<br />PRE— MISES.C��enca) ._
<br />MED EX_P (Any one person)
<br />-$
<br />$ 1_,000,000._
<br />$ 75 000.
<br />E �
<br />_
<br />1,000000_
<br />��_. ____ _______ _ __ __
<br />PERSONALBADV INJURY
<br />_ -
<br />-__
<br />S_ 2,000 GOO.
<br />I)II
<br />_ _ .._ ___ .__. _
<br />�
<br />AGGREGATE
<br />_GENERAL
<br />PRODUCTS - GOMP/OP AGG
<br />$ 2,000,000.
<br />GEN'L AGGREGATE LIMIT APPLIES PER I
<br />X POLICY PRO- LOG
<br />_ _
<br />$
<br />C
<br />' AUTOMOBILE
<br />_-
<br />LIABILITY X 094107666 09/25/2012
<br />I
<br />�09/25l2013
<br />M WED INGLE LIMIT
<br />Vie,. aocidenil
<br />�_$ _ 1 ,OO_0,000-
<br />'� $
<br />ANY AUTO I, �
<br />j BODILY INJURY (Par person)
<br />_
<br />ALL OWNED - � SCH EDULEO - -
<br />AUTOS _X AUTOS
<br />NON-0WNED I
<br />HIRED AUTOS _X _ gUT05 I
<br />-
<br />80DILY INJURY (Par ecsitlant)
<br />PROPERTY DAMAGE
<br />accden[) ._
<br />$
<br />_ _____._-
<br />$
<br />X�
<br />$
<br />UMBRELLA LIAB .00CUR �
<br />�
<br />EACH OCCURRENCE
<br />$
<br />-_ _ _
<br />AGGREGATE
<br />—_-
<br />EXCESS uAB � CLAIMS -PAADE
<br />!
<br />$
<br />DEO RETENTION$
<br />I
<br />S
<br />D
<br />j WORKERS COMPENSATION
<br />AND EMPLOYERS' LIA6ILITY Y l N
<br />ANV PROPRIETOR /PARTNER/EXECUTIVE � i N ! A
<br />OFFICER/MEMBER EXCLIJDEDI
<br />{Mandatory In HH)
<br />!
<br />A09203249 -1 2 109/24/2012
<br />WC STATU- OTH-
<br />09/24/2013 �;_7r,RY I Mlrg _ __ _ _ _ __
<br />E.L. EACH ACCIDENT � $ 1 ,000,000.
<br />- "- --
<br />E.L. DISEASE - EA EMPLOYEE' $ 1 ,000 GOO,
<br />II yym, daxrlba under
<br />DESCRVPTION OF OPERATIONS below
<br />I
<br />_
<br />_ - -
<br />E.L. DISEASE - POLICY LIMIT I $ 1 ,000.000.
<br />B
<br />PROFESSIONAL LIABILITY � i E0000020812 -01 09/25/201209/25
<br />i
<br />/2013 $1,000.000. PER OCC.
<br />$1,000,000. AGGREGATE
<br />DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Atbclr ACORD 101, AddNlonal Rrrlsuka achadala. Ir more epees N required)
<br />THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701; ITS
<br />OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS
<br />( "ADDITIONAL INSUREDS ") WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM THE OPERATIONS
<br />AND USES PERFORMED BY���i�l�F O��H Er�h��F�RED PER ENDORSEMENT U156PC -0310
<br />V CRIIt- IA.AIC I"IVLU CR {,3AIYliCLLAIIV IV
<br />i�SS1StHIIL y A 1 LUTney gHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTCE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA,
<br />SANTA ANA, CALIFORNIA 92701; AurwoR¢ED REPRESENTAnvE
<br />® 1968 -20'10 ACORD CORPORATION_ All rlphts reserved.
<br />ACORD 25 (2010/05) The ACORD name and loco are reralste red marks of ACORD
<br />
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