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ACOR" CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 01/10/2013 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: SC ASSOC Ins Services Inc PHONE FAX A/C No (AIC, No): E-MAIL ADDRESS: 2659 TOWNSGATE RD STE 102 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: DEPOSITORS INSURANCE COMPANY 42587 WESTLAKE VILLAGE CA 91361 INSURED INSURER B INSURERC: _ INSURER D: CHAMBERS GROUP, INC INSURER E 5 HUTTON CENTRE DR STE 750 IRVINE CA 92707-8720 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE LTR ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I_] OCCUR - DAMAGETORENTE0_ PREMISES Ea occurrence S MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ Ji PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT $ AUTOMOBILE LIABILITY.,: X s ; „ Ee acc dent IN LE LIMIT $ 1'000'000 x ANY AUTO BODILY INJURY (Per person) $ A x ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED ! HIRED AUTOS x AUTOS ACP BAPD 2515084678 06/01/2012 06/01/2013 P BODILY INJURY (Per accident ( ) $ PROPERTY DAMAGE Per accident $ s UMBRELLA LIAB CI' L10LAURI.,_1 EACH OCCURRENCE $ EXCESS LIAR ADE • . 1'0RT GGREGATE $ DED RETENTION $S $ WC STATU- OTH-' AND EMPLOYERS' LIABILITY ANOYRKERS PROPRIETOR/PAR NOER/EXECUTIVE YIN OFFICE/MEMBER EXCLUDED' ❑ N / A .-..- i t - - J .0 �.(„_. - TORY LIMITS ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE S (Mandatory In NH)-,.«,. If yes, describe under DESCRIPTIONATI :✓au S> a Stltt S�1 �%dy E.L. DISEASE - POLICY LIMIT S Assistant 1-11Y DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, its officers, elected and appointed officials, employees, agents,and volunteers are to be covered as additional insureds With respect to liability arising out of work performed by or on behalf of the Consultant. Certificate holder is listed as additional insured under form CA2048B. Waiver of subrogation applies per form AC2404B. 10 day notice of cancellation for non-payment, 30 days for all other Vf11YV CLL/1 11WIY City of Santa SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Cemter Plaza (M-30) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1988 Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE NEIL CHURCHILL ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD