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,�►coRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must bd4ndorsed. if SUBRO(*TI9lllII IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this dettifiMtee-d6es not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Wood Gutmann & Bogart Lic #0679263 15901 Red Hill Ave., Suite 100 CT NAMN E't` _ Robin. : PHONE FAX - A/C No : - - E -MAIL - ADDRESS: INSURERS AFFORDING COVERAGE NAIC q Tustin CA 92780 INSURER A:Assurance Company of America PAS037514693 /26/2012 INSURED ARELL -1 INSURER B:Hartford $2,000,000 INSURER C:Ph*ladelph*a Indemnity Ins Co. X COMMERCIAL GENERAL LIABILITY Arellano Associates Genoveva Arellano ©rs 5851 Pine Ave Ste A '• Chino Hills CA 91709 p� G, W INSURER D : INSURER E : DAMA E TO RENTED PREMISES Ea occurrence INSURER F: COVERAGES CERTIFICATE NUMBER: 1533492479 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DDIYYYY LIMITS A GENERAL LIABILITY PAS037514693 /26/2012 /26/2013 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMA E TO RENTED PREMISES Ea occurrence $2,000,000 CLAIMS -MADE IT] OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $4,000,000 1 $ POLICY PRO LOC A AUTOMOBILE LIABILITY PAS037514693 /26/2012 /26/2013 Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X N ED HIRED AUTOS X AUTOS $ A UMBRELLA LIAB X OCCUR PAS037514693 /26/2012 /26/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $0 $ B WORKERS COMPENSATION 72WECDQ0297 /27/2012 /27/2013 X I WC STATU- OTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I I I E.L. DISEASE - POLICY LIMIT $1,000,000 C A Errors & Ommissions Valuable Papers & Records PHSD736305 PAS037514693 /8/2012 /26/2012 /8/2013 /26/2013 2,000,000 /Claim 2,000,000 /Agg 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: All Operations for the City of Santa Ana Certificate holder is named as additional insured on the General Liability per attached 9S2001 04 99. Primary and Non - Contributory applies on the General Liability per attached 9S2001 04 99. THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED. CERTIFICATE HOLDER CANCELLATION City of Santa Ana T Caura Stit Sheedy 20 Civic Center Plaza Assistant City Attorney Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P ,A R ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD