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.4CORl7®CERTIFICATE OF LIABILITY INSURANCE �� DAT D/YYYY) 06/25/2612512013 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 pollcy(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 CO NAME; SC Associates Insurance Services, Inc PHONE FAX GENERAL LIABILITY 2659 TOWNSGATE RD -=as: INSURERS AFFORDING COVERAGE NAIL tr STE 102 INSURER A: DEPOSITORS INSURANCE COMPANY 42587 WESTLAKE VILLAGE CA 91361 INSURED INSURER B: INSURER C: �` INSURER D: CHAMBERS GROUP, INC INSURER H: 5 HUTTON CENTRE DR STE 750 INSURER F: SANTAANA CA 92707.8720 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 LTR TYPE OF INSURANCE ADOLSUB POLICY NUMBER POLICY MMIODYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E� OCCUR �` NMAGE TO RENTED PREMISES Ea occurrence S MED EXP (Any one son $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN1_ AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S POLICY PR0. LOC JECTINFO $ AUTOMOBILE LIABILITY X ! X I Eaeooldent I LE LIMIT $ 1,000, DOO BODILY INJURY(Per person) $ ANYAUTO AAuros Ix ALL OWNED SCHEDULEDAUTOS NOR -OWNED HIRED AUTOS X AUTOS ACP BAPD 2525084678 06101/2013 06/01/2014 BODILY INJURY Per accident) S PROPERTY DAMAGE S Per accident S I UMBRELLA LIAROC HCl:.:l-MADE EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR DED RETENTIONS $ WORKERS COMPENSATIONVYC AND EMPL.OYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y I N OFFICFJMEMBER EXCLUDED? ❑ N i A STATU- OTH- T RY IMI7ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPFRATIQM�—�E.L. DISEASE - POLICY LIMIT $ FI DESCRIPTION OF OPERATIONS I LDCAMONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) The "Clerk ofthe City Council" is named as additional insured. However, "The City of Santa Ana, its officers, employees, agents and representatives", should the additional insured. Certificate holder is listed as designated insured under form CA2048 F Waiver of subrogation applies per form CA0444 c CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Clerk of the City Council SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, M30 P.O. Box 1988 AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 Neil Churchill ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD