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ASR°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/30/2012 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 i k i CONTACT NAME Aon R s Insurance Serv ces west, Inc. FAX PHONE 866 LOS Angeles CA office -7122 -5390 ) 283 A/C. No. (847) 953-5390 (A/C. No. Ext) ( 707 Wilshire Boulevard E-MAIL Suite 2600 ADDRESS LOS Angeles CA 90017-0460 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA Great Northern Insurance Co. 20303 Tiburon, Inc. INSURERB Federal Insurance Company 20281 6200 Stoneridge Mall Pleasanton CA 94588 USA INSURERC Pacific Indemnity Co 20346 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 570047360891 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR wVD POLICY NUMBER MMIDDIYYYY MMIDDIYWY LIMITS B GENERAL LIABILITY 35911023 69/01/201? 09/01/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIAB LITY DAMA 'F TO RENTED P REMISES Ea occurrence $1, 000, 000 CLA MS-MADE X? OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE L MIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO X LOC IFCT A AUTOMOBILE LIABILITY 7355-87-29 09/01/2012 09/01/2013 COMB NED S NGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY NJURY ( Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY NJURY (Peraccident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB H CLAIMS-MADE AGGREGATE DED RETENTION C EMPLOYER COMPPEENSTAITION AND YIN 71739717 09/01/2012 09/01/2013 X TORY L _TAT OTTH ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICERIMEMBER EXCLUDED? N? N I A E L. EACH ACC DENT $1,000,000 (Mandatory in NH) If yes descnbe under E L. DISEASE-EA EMPLOYEE $1,000,000 , DESCRIPTION OF OPERATIONS below E L. DISEASE-POLICY L MIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Santa Ana its officers, employees, agents, volunteers and representatives is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability and Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE 60 Civic center Plaza Santa Ana CA 92701 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD V,t C?_?: -tu --Ct v rl `m c m 73 d O 2 m a0 M v 0 O Z d f0 V O) U