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0 a OP ID: PC
<br />CERTIFIC, _TE OF LIABILITY INSUR. .SCE
<br />COVERAGES CERTIFICATE NUMBER: 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 />DATE 0913011
<br />09/30/11
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<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 />ILTR
<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 />INSR
<br />WVD
<br />PRODUCER 626 -405 -8031
<br />Chapman 626 -405 -0585
<br />License #0522024
<br />P. 0. Box 5455
<br />Pasadena, CA 91117 -0455
<br />CONTACT
<br />NAME:
<br />MM /DD //Y YY
<br />PHONE FAX
<br />Ext A/C No
<br />E- -MAILo
<br />ADDRESS:
<br />PRODUCER INTER -5
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED Interval House
<br />P.O. Box 3356
<br />Seal Beach, CA 90740
<br />INSURER A:Riverport Insurance Company
<br />36684
<br />A
<br />INSURER B: Everest National
<br />10120
<br />INSURER C:
<br />RIC0012016
<br />INSURER D :
<br />10/01/12
<br />INSURER E :
<br />$ 100,000
<br />INSURER F
<br />$ 5,000
<br />COVERAGES CERTIFICATE NUMBER: 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 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 />ILTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />MM DD/YYYY
<br />MM /DD //Y YY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X7 COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I I OCCUR
<br />X
<br />RIC0012016
<br />10/01/11
<br />10/01/12
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X Professional Liab
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />X
<br />Sexual Abuse Liab
<br />GENERALAGGREGATE
<br />I$ 3,000,000
<br />p AS
<br />��
<br />TO FO
<br />M
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OPAGG
<br />$ 3,000,000
<br />POLICY PE° LOC
<br />Prof Liab
<br />$ 1mil /3mil
<br />AUTOMOBILE
<br />LIABILITY`
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />-- LISA �•• S
<br />nom..,. .. -.,,+ Cat
<br />_�[
<br />OpCK
<br />t��
<br />. Attorney
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />l
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />$
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />REL0012017
<br />10!01!11
<br />10/01/12
<br />AGGREGATE
<br />$ 2,000,000
<br />DEDUCTIBLE
<br />$
<br />X
<br />RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVEY /N
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />6600000287111
<br />02/01/11
<br />02/01/12
<br />WC STATU- OTH-
<br />X TORY LIMIT X ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000000
<br />'
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />•
<br />Property Coverage
<br />RIC0012016
<br />10/01/11
<br />10/01/12
<br />BlktCont 425,000
<br />•
<br />Crime Coverage I
<br />IRIC0012016
<br />10/01/11
<br />10/01/12
<br />Empl Dish 200,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re! #A- 2010 - 061 -002; A- 2009 -133; A- 2009 -133A. City of Santa Ana,
<br />its officers, employees, agents, volunteers and representatives are named
<br />additional insured with respect to the General Liability policy of the named
<br />insured - CG 2026 endorsement to follow. Such insurance is primary and
<br />non-contributory per the attached endorsement. Workers Compensation Contd.
<br />l,N1Y �.. CLLFI 1 1 V IV
<br />CITY016
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Community Dev. Agency (M -25) AUTHORIZED REPRESENTATIVE
<br />Attn: Frank Hernandez
<br />20 Civic Center Plaza, M -25
<br />Santa Ana CA 92701
<br />U 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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