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A? °? CERTIFICATE OF LIABILITY INSURANCE 1DATE /23/2013)
<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 />-PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />rMPORTANT: 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 Am Alberdin
<br />NAME: y g
<br />SPIB Insurance Agency, Inc. PHAIC. No ONE . (949)582-5220 ac No: (949)582-3512
<br />License Number 0719264 E-MAIL .amy@spib.com
<br />26441 Crown Valley Parkway#200 INSURERS AFFORDING COVERAGE NAIC#
<br />Mission Viejo CA 92691 INSURERA:Peerless Insurance Co 24198
<br />INSURED INSURERB:The Netherlands Insurance Co 24171
<br />Rue Vac Property Services Inc INSURERc:Golden Eagle Insurance Corp. 10836
<br />600 W. Taft Avenue INSURERD:State Co Insurance Fund 210
<br /> INSURER E :
<br />Orange CA 9 2 8 6 5 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER_2MSTR13-14WC-GL-A-U-P RFVISION NIIMRFR-
<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 />LTR TYPE OF INSURANCE A POLICY NUMBER MWDDY/YYYY MWDD/YYYY LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />
<br />X
<br />COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
<br />
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />A CLAIMS-MADE OCCUR BP9558563 /1/2013 /1/2014 MED EXP (Any one person) $ 5,000
<br /> PERSONAL i£ADVINJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER.:
<br />- PRODUCTS - COMP/OP AGG $ 2,000,000
<br />
<br />] RO- LOC
<br />X POLICY P
<br />J-CT F
<br />$
<br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000, 000
<br />B X ANY AUTO BODILY INJURY (Per person) $
<br /> ALL OWNED
<br />AUTOS SCHEDULED
<br />AUTOS A9797086 /1/2013 /1/2014
<br />BODILY INJURY (Per accident)
<br />$
<br />
<br />X
<br />HIRED AUTOS
<br />N NON-OWNED
<br />AUTOS PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br /> X COMP PER SCH x COLL PER SCH Underinsured motorist rooerN $
<br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br />C X EXCESS LIAB CLAIMS-MADE _
<br />AGGREGATE $ 1,000,000
<br /> DEC RETENTIONS U9558863 /1/2013 /1/2014 $
<br />D WORKERS COMPENSATION X WC STATU- C T H-
<br /> AND EMPLOYERS' LIABILITY R
<br /> Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />?
<br />OFFICER/MEMBER EX
<br />N / A E.L. EACH ACCIDENT $ 11000,000
<br /> CLUDED?
<br />(Mandatory in NH) 9038319-13 1/1/2013 1/1/2014 E.L. DISEASE- EA EMPLOYE $ 11000,000
<br /> If yes, describe under
<br /> DtSCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A PROPERTY, SPECIAL FORM CBP9558563 /1/2013 /1/2014 BUILDING 1,248,480
<br /> REPL COST $1000 DED BUSINESS PERS PROPERTY 104 , 04 0
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E. SANTA ANA BLVD., SANTA ANA, CA.
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS
<br />ADDITIONAL INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM GECG 602 0111 SECTION V, A &
<br />B. PRIMARY AND NON-CONTRIBUTORY WORDING IS PROVIDED IN FORM # 22-111 01/07.
<br />riTRUVED AS TO FORM
<br />?.crn r rrrt,H 1 nv?ur=n GANGtLL.A I IUN
<br />dUra S( Sheerly SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />A?-i,t -inCity .Atlorne,, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />THE CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE
<br />L Hines, CPCU ARM CLUlirtri
<br />AUUKU 25 (2U10/05) © 1988-2010 ACORD CORPORATION. All rights reserved.
<br />INS025 ;201 eos;.ot The ACORD name and loco are reaistered marks of ACORD
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