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<br />A CERTIFICATE OF LIABILITY INSURANCE D/28/2013Y)
<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(les) 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 rabic
<br />NAME
<br />-
<br />MOC Insurance Services PHONE (415)957-0600
<br />AC (415)959-0597 Net.
<br />
<br />License No. 0569960 a
<br />E'oIL .ddefabio@maroevich.oom
<br />44 Montgomery St., 17th Fl. INSURERS AFFORDING COVERAGE NAICM
<br />San Francisco CA 94104 INSURERA:Golden Eagle Insurance Co 10836
<br />INSURED INSURER B:Re UbliC Indermnit Company of 22179
<br />Keyser Marston Associates, Inc. INSURER C:Evans ton Insurance Co. 35376
<br />55 Pacific Avenue Mall INSUaeR O:
<br /> NSURER E:
<br />San Francisco CA 94111 INSURER F:
<br />COVERAGES CERTIFICATE NUMBERMASTER 2012-13 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 DR 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 TYPE OF INSURANCE ADDL UBR
<br />POLICYNUMBER POLICY EFF
<br />YY POLICY EXP
<br />/Do
<br />LIMITS
<br /> GENERALUABILITY EACH OCCURRENCE_ $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY EDAMAGES( R rre oELATE n ISET E e $ 500,000
<br />A CLAIMS-MADE ? OCCUR X BP8932329 12/1/2012 12/1/2013 MED EXP (Any one person $ 10,000
<br /> o Deduotible applies PERSONAL &ADV INJURY $ 1,000,000
<br />
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEDPL AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
<br /> POLICY X PRO LOC $
<br /> AUT OMOBILE LIABILITY E8 BIKED SINGLE LIMIT 1,000,00o
<br />A X ANY AUTO o
<br />APPROVED `GL AS rO FOR BODILY INJURY (Per person) $
<br /> ALL OWNED
<br />AUTOS SCHEDULED
<br />AUTOS X A 89324
<br />
<br />29 12/1/2012 12/1/2013 BODILY INJURY(Psraccldent) $
<br /> X HIRED AUTOS X NON _OWNED
<br />AUTOS PROPERTYD MMA08
<br />(Per I $
<br /> X Camp $500 X Coll $600 Uninsured Motorlst Combined $ 1 000, DDO
<br /> X UMBRELLA LIAR X OCCUR
<br />?- EACH OCCURRE 4
<br />000
<br />000
<br /> H
<br />It O DGE NCE ,
<br />,
<br />$
<br />A EXCESS LIAR CLAIMS-MADE . AGGREGATE $ 4,000,000
<br /> LED X RETENTION$ 510,000 X ?pe
<br />O 893262 y IMA9PZe'I 12/1/2D13 I $
<br />
<br />13
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY
<br />X WCSTATU- OTH-
<br />OR LIM
<br />ER -
<br />
<br />-
<br /> YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />?
<br />NIA E.L. EACH ACCIDENT $ 1 ODD DDD
<br /> OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH) 03954618 12/1/2012 12/1/2019
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,00
<br />0
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1 00D 000
<br /> Professional Liability 0-852080 12j1/Z012 12f1/201.3 Each Wrongful Act $1,000,000
<br /> Retention: $50,000 etro Data 11/7.1/1976 AGGREGATELIMIT $2,000,000
<br />DESCRIPTION OFOPERATIONS 1 LOCATIONS I 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 with
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any
<br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />Executive Director of PEA
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br /> Donna de Fabio/DDF cr+M. vrsa,.,,
<br />ACORD 26 (2010/06)
<br />INS 025 (2010D5) at
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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