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A H CERTIFICATE OQ{F� LIABILITY INSURANCE
<br />Ill
<br />DA 04/16/2013
<br />CERTIFICATE IS
<br />NOT CONFERS NO RIGHTS UPON THE
<br />ALTER THE COVERAGE AFFORDED CERTIFICATE HOLDER.
<br />POLICIES IS
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, ANQ T,HE,CERTIFICATE,HOj_QFFR.
<br />IMPORTANT: If the certificate holder 1 n,ADD TIONAL INSURFO the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the polic tsartbain.poli�ies may.CegUJ il endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Pro -Form Sinclair Professional
<br />15 Allstate Parkway, Suite 310
<br />CONTA T Dafna Warshager
<br />ONE H 905- 305 -1054 FAX, 905- 305 -1093
<br />P HO No Ext : A/C No
<br />E -MAIL
<br />ADDRESS: 9 dafna.warsha er hubinternational.com
<br />Markham, ON L3R 5B4
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />Santa Ana„ CA 92702
<br />INSURER A :XL Insurance America, Inc.
<br />24554
<br />04/30/2013
<br />INSURED
<br />BI Group
<br />INSURER B :XL Specialty Insurance Company
<br />37885
<br />INSURER C
<br />X COMMERCIAL GENERAL LIABILITY
<br />Cl-AIMS-MADE FTIOCCUR
<br />18401 Von Karmen Avenue, Suite 110
<br />Irvine, CA 92612
<br />INSURER O:
<br />INSURER 1;
<br />PREMISES Ice occurrence)
<br />�r
<br />'V
<br />INSURER F:
<br />$ 5,000
<br />COVERAGES CERTIFICATE NUMBER:T27E5H9N 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 RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />R
<br />TYPE OF INSURANCE
<br />Ill
<br />SUDR
<br />POLICY NUMBER
<br />MMIDO/YYYYY
<br />MMID�IVYYV
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />Santa Ana„ CA 92702
<br />US00008637LI 13A
<br />04/30/2013
<br />04/30/2014
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />Cl-AIMS-MADE FTIOCCUR
<br />PREMISES Ice occurrence)
<br />$ 100,000
<br />MILD EXP(Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />X Contractual Liability
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMP /OP AGO
<br />$ 2,000,000
<br />X POLICY PRO LOG
<br />JECT
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />MAGO037604
<br />Deductible: $500 Comp. / $1,000
<br />05/20/2012
<br />05/20/2013
<br />COMBINED SINGLE LIMIT
<br />c
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANVAUTO
<br />Collision
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED AUTOS X NON-OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />X
<br />$500 Com/
<br />1,000Csion
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />WC STATU- OTH-
<br />TO V LIM TS ER
<br />E, L. EACH ACCIDENT
<br />$
<br />ANY PROPRIETORMARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />NIA
<br />E, L. DISEASE EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L .DISEASE - POLICY LIMIT
<br />$
<br />B
<br />Professional Liability Insurance
<br />DPR 9707260
<br />04/30/2013
<br />04130/2014
<br />Each Claim
<br />$ 1,000,000
<br />Annual Aggregate
<br />$ 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ADDED 101, Additional Remarks Schedule, If more space Is required)
<br />REG: I2- 27980; City of Santa Ana Regional Transportation Center (SARTC) Master Plan
<br />"City of Santa Ana, its officers, agents, representatives, volunteers and employees" are added as additional insured to Commercial General Liability /Non -Owned Auto but
<br />only with respect to liability arising out of the operations of the named insured. With respect to Commercial General /Non -Owned Auto, the policy(ies) described above shall
<br />apply as primary for the operations of the named insured on behalf of the City of Santa Ana. A cross liability clause is
<br />included in the policy wording. The Insurer will provide the certificate holder with thirty (30) days written notice of cancellation of the policy.
<br />Limits shown are in US Dollars
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010105)
<br />Page 1 of 1 ©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />t,
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />f..dLira at Sheody,
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza (M -30) y
<br />P.O. BOX 1985 psaiRta Dr. (.ItY AttOT11C
<br />Santa Ana„ CA 92702
<br />-— - -
<br />ACORD 25 (2010105)
<br />Page 1 of 1 ©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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