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<br />a-g-. (-)-O <br />271069 <br />CERTIFICATE OF LIABILITY INSURANCE DAT <br />°IYYYY) <br /> 3 <br />/28/2 <br />3/28/2013 <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(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 />PRODUCER CONTACT <br />NAME: <br />Commercial Lines - (818) 464-9300 PHONE Fax <br /> AC No E 1: _ AICCio): <br />- <br />Wells Fargo Insurance Services USA, Inc. - CA Lic#'. OD08408 EMAIL <br /> AnORESS: <br />15303 Ventura Boulevard, 7th Floor INSURER(S) AFFORDING COVERAGE NAIL # <br />Sherman Oaks, CA 91403-3197 INSURER A: Philadelphia Indemnity Insurance Company 18058 <br />INSURED I_ ^Of f 03(o <br />C 1 I <br />?V INSURER B, Philadelphia Insurance Company 23850 <br />e <br />Discovery Science Center INSURER C: Employers Compensation Ins Cc 11512 <br />2500 North Main Street INSURER D: Travelers Casualty & Surety Co. of America 31194 <br />Santa Ana, CA 92705 <br /> INSURER E <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: bUb0bU/ REVISION NUMBER: Si helm. <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 />INSR <br />LTR <br />TYPE OF INSURANCE ADDL <br />IN.F SUBR <br />POLICY NUMBER POLICY EFF <br />MMIDDIYYYY POLICY EXP <br />MMIDDIYVVY <br />LIMITS <br />A GENERAL LIABILITY X PHPK953782 12/15/2012 1211512013 EACH OCCURRENCE _ $ 1,00D,00D <br /> <br />X <br />COMMERCIAL GENERAL LIABILITY DAMAG TO RENT o'nancb <br />PREMIESRea or ED <br /> CLAIlNS MADE X OCCUR MFD EXP (Any one person) _ ME <br />5 <br /> P <br />RSONAL& REV INJURY <br />000 <br />11000,000 <br />$ <br /> E <br />_ 1,00 <br />,000 <br /> GENLAGGRE <br />GATE LIMITAPPPLIES PER: <br />_..._ PRODUCTS - COMP/OPAGG $ 2,000,000 <br />- <br /> f <br />1 PRO LOC <br />X j POLICY I <br />L?1 -- <br />A AUTOMOBILE LIABILITY P-{PK953]$Q 12115/2612 12/15/2613 COMBINED SINGLE LIMIT <br />(Ea acmd.rn) 1,000,000 <br />$ <br /> _ <br />X I ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED <br />BODILV INJURY (Pera idenf) '- <br />$ <br /> AUTOS A <br />UTO <br />S i <br /> NON <br />O <br />WNED <br />X? <br />X HIRED AUTOS <br />AUTOS PROPERTY DAMAGE <br /> <br />Per. siidene <br /> <br />$ - - <br /> I 1 5 <br />B UMBRELLA UAB x_ OCCUR PHU8404496 12/15/2012 12/15/2013 EACH OCCURRENCE 5 10,000,000 <br /> EXCESS LIAB CLAIMS-MAD'c IiI AGGREGATE _ <br /> DED RETENTIONS <br /> WORKERS O <br />x <br />G EIG1453813-01 <br />AND EMPi <br />YIN 04101113 04101/14 Toav uMlTS _ <br /> ANY PROPRIETORIPARTNERIEXECUTIVE <br />B? NIA E.LEACH ACCDENT t <br /> <br />OFFICER/MEM <br />1Mantlatory in NH) <br />L DISEASE - EA EMPL <br />E i <br /> yesdescribe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY L <br />D D&O, EPL, Fiduciary, Crime 105645707 <br />I! I , 0613012012 06/30/2013 3,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CG 20 26 07 04 The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and <br />representatives are included as Additional Insureds for General Liability and defense of suits arising from the operations and uses performed by or on <br />behalf of the Named Insured per the attached. Cancellation Notice to Scheduled Additional Insured also attached, The coverage is primary and <br />non-contributory with other insurance held by the City. Separation of insureds applicable per the policy form, <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana SHOULD <br />ABOVE <br />BE CANCELLED BEFORE <br />H <br />I <br />Attn: Risk Management MM <br />V THE <br />EXPIRATIION <br />DATE <br />THE THEREOF, NOTICE <br />WILL <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />p¢?dq <br />Santa Ana CA 92791 0 V <br />(7 AUTHORIZED REPRESENTATIVE <br /> l/ <br />c?1??{ o riey Jt <br /> a <br />Th. '"6RD ne`'h'SXjBnff B6,5 a a registered marks of ACORD © 1988.2010 ACORD CORPORATION. All rights reserved. <br />/ <br />ACORD 25 (2010/05) p,5 1