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A? °® CERTIFICATE OF LIABILITY INSURANCE 1/28/201Y3
<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 CONTACT Donna de Fabio
<br />NAME:
<br />MOC Insurance Services PHONE (415) 957-0600 AA/C No (415)957-0577
<br />License No. 0589960 E-MAIADURLESS: ddefabio@maroevich. com
<br />44 Montgomery St., 17th Fl. INSURERS AFFORDING COVERAGE NAIC #
<br />San Francisco CA 94104 INSURERA-.Golden Eagle Insurance Co 10636
<br />INSURED INSURER B.RePUbliC, Indemnity Company of 22179
<br />Keyser Marston Associates, Inc. INSURER C -Evanston Insurance Co. 5376
<br />55 Pacific Avenue Mall INSURER D:
<br /> INSURER E ;
<br />San Francisco CA 94111 INSURER F:
<br />COVFRAnPR CFRTIFICATF NIIMRFR•MASTER 2012-13 RFVI-glnN NI IMRFR-
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE ADDL SUBR
<br />POLICY NUMBER POLICY EFF
<br />MMIODIYYY POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE
<br />- $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY
<br />
<br />
<br />-
<br />TO RENTE5
<br />-
<br />PREMISES
<br />Ea occurrence
<br />
<br />$ 500,000
<br />A CLAIMS-MADE F
<br />x1OCCUR X BPO932329 12/1/2012 12/1/2013 MED EXP (Any one person) $ 10, 000
<br /> O Deductible applies PERSONAL & ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER:
<br />- PRODUCTS - COMP/OP AGG $ 1,000,000
<br /> POLICY X PRO-
<br />1 LOC
<br />JFCT F
<br />$
<br /> AUT OMOBILE LIABILITY COMBINED N LELIMIT
<br />(Eq B' nt
<br />1 000 000
<br />A x ANY AUTO BODILY INJURY (Per person) $
<br /> ALL OWNED
<br />AUTOS SCHEDULED
<br />AUTOS X A 8932429 12/1/2012 12/1/2013 BODILY INJURY (Per accident) $
<br /> X HIRED AUTOS X NON-OWNED
<br />AUTOS PROPERTY DAMAGE
<br />P r c ident
<br />
<br />$
<br /> X Camp $500 X Coll $500 Uninsured Motorist Combined $ 1,000,000
<br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000
<br />A EXCESS UAB CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED X RETENTION$ $10,00 X U 8932629 12/1/2012 12/1/2013 $
<br />$ WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY X WC STATU- OTH-
<br /> Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />N/A E.L. EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH) 3954618 12/1/2012 12/1/2013 E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />C Professional Liability 0-852080 12/1/2012 12/1/2013 Each Wrongfull Act $1,000,000
<br /> Retention: $50,000 etro Date 11/11/1976 AGGREGATE LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / 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 wi
<br />i
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory wit(5n
<br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<br />AS
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<br />VCM I Irl"M 1 C n%JL.UClrt L ANL rLLA I IUN I Z/VJ"-? \tiYl r
<br />City of Santa Ana
<br />Executive Director of P13A
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POL100-23'6E CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />de Fabio/DDF -, C?+vvw....+ c,
<br />AUUKU ZO (ZUTUIUb) U 1988-2010 ACORD CORPORATION. All rights reserved.
<br />INS026 (201005).01 The ACORD name and logo are registered marks of ACORD
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