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OP ID: JU
<br />ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE
<br />
<br />IYYYY)
<br />(MMIDD
<br />10/09/1 2
<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 858-259-5800 CONTACT
<br />NAME:
<br />Leavitt Ins Agency San Diego
<br />
<br />CA License #0872756 858-259-6069
<br />HONE FAX
<br />P
<br />(AC No Ext : A/C No):
<br />380 Stevens Ave., First Floor E-MAIL
<br />ADDRESS:
<br />Solana Beach, CA 92075 PRODUCER IPSGR-1
<br />CUSTOMER ID #:
<br /> INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED IPS Group Inc. INSURER A: National Fire Ins of Hartford 20478
<br />5601 Oberlin Drive, Suite 100 INSURERB:American Casualty Company 20427
<br />San Diego, CA 92121 INSURER C: Continental Casualty Co 20443
<br /> INSURER D : Valley Forge Insurance Co 20508
<br /> INSURER E :
<br /> INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 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 />ILiR R
<br />TYPE OF INSURANCE
<br />INSR
<br />ADDL B
<br />WVD
<br />POLICY NUMBER
<br />MM/DDfYYYY
<br />MM DD/YYYY
<br />LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />A X COMMERCIAL GENERAL LIABILITY X 4034371571 10/19/12 10119/13 PREMISES Ea occurrence $ 500,00
<br /> CLAIMS-MADE [XI OCCUR MED EXP (Any one person) $ 15,000
<br /> PERSONAL & ADV INJURY $ 1,000,00
<br /> GENERALAGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER:
<br />_ PRODUCTS -COMP/OP AGG $ 2,000,000
<br />
<br />_ POLICY X PR? LOC
<br />1 F Emp Ben. $ 1,000,000
<br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1
<br />000
<br />000
<br />B 40343715 10/19/12 10/19/13 (Ea accident) ,
<br />,
<br /> ANY AUTO 54
<br />NO OWNED AUTOS BODILY INJURY (Per person) $
<br /> ALL OWNED AUTOS BODILY INJURY (Per accident) $
<br /> SCHEDULEDAUTOS
<br />PROPERTY DAMAGE
<br />
<br />X
<br />HIREDAUTOS
<br />(Per accident) $
<br /> X NON-OWNEDAUTOS $
<br />
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br />C 4034371568 10/19/12 10/19113
<br /> DEDUCTIBLE $
<br /> X RETENTION $ 10,000 $
<br /> WORKERS COMPENSATION X WC STATU- OTH-
<br /> AND EMPLOYERS' LIABILITY TORY LIMITS ER
<br />D ANY PROPRIETOR/PARTNER/EXECUTIVEY/N
<br />?
<br />N/A 4022979152 CALIFORNIA 03/19112 03119/13 E.L. EACH ACCIDENT $ 1,000,000
<br />D OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH) 4022979166 03/19112 03/19/13 E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br /> If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A Tech E&O/Network/ 4034371571 10/19112 10/19113 Occurrent 5,000,000
<br /> Privacy/Media Aggregate 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Engineering of Parking Meters. Certificate Holder is additional insured per
<br />form G144294C99 when required by written contract. Coverage is Primary per
<br />form G144294C99 when re
<br />uired b
<br />written contract
<br />Se aration of ins
<br />reds
<br />q
<br />y
<br />.
<br />u
<br />per policy form CG0001. 30 day cancellation notice per form G151 15A.
<br />CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />The City of Santa Ana, its ACCORDANCE WITH THE POLICY PROVISIONS.
<br />officers, agents, volunteers,
<br />employees and representatives
<br />20 Ci
<br />i
<br />C
<br />t
<br />Pl AUTHORIZED REPRESENTATIVE
<br />AS TO FC):r.
<br />v
<br />c
<br />en
<br />er
<br />aza ) k?PROVED
<br />Santa Ana, CA 92701
<br />©1988-2009 ACORD I?ORaTin? hts reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD LISA E. STORCK-
<br />Assistant CitN, """'
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