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ACORD CERTIFICATE OF LIABILITY INSURANCE DATEJUN 24133Y) M. T PRODUCER MARK JACKSON INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 775 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR YORBA LINDA CA 92885-0775 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE: 714-779.2629 1.. FAX: 714-779-1170 Agency Lic#: 0673236 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: U.S. Liability Insurance Company 1125895 ACIRE, INC. INSURERS: 211 SIMPLICITY IRVINE, CA 92620 INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LT TYPE OF INSURANCE POLICY NUMBER POLICY CTIVE EFFE DALE IMIID POUCYEXPIRATION DATE MMDD LIMITS GENERAL LIABILITY PPPI006536E JUL 612 JUL 613 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES(Ea o—m— $ 50,000 X COMMERCIAL GENERAL LIABILITY _ CLAIMS MADE � X OCCUR MED. EXP (Any One Person) $ 5,000 PERSONAL& ADV INJURY $ 11000,000 A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG. $ 1,000,000 POLICY AUTOMOBILELIABILITY ANY AUTO PPPI006536E JUL 612 JUL 613 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY ALL OWNED AUTOS A SCHEDULED AUTOS (Per person) $ BODILY INJURY (Per acdtlant) $ X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE 5 GARAGE LIABILITY APPROVED AS TO FORM AUTO ONLY - EA ACCIDENT S THAN FAACC $ ANY AUTO 2OTHER i. AUTO ONLY: AGG _ $_�_--��--__� EXCESS I UMBERELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE Laura IIILI Needy AGGREGATE $ Assistant City Attorney $ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WTDRY LIMITSCSTLAZ- OTHER —' E.L. EACH ACCIDENT $ ANY PROPRIETOR RIEXELUTIVE $ '. OFFICfRIYAMBER EXCLUDED? ' E.L. DISEASE -EA EMPLOYEE Ryes,Ae FCA unWr SPECIAL PROVIsroes W. E.L. DISEASE -POLICY LIMIT $ OTHER: PROFESSIONAL LIABILITY PPP1006536E JUL 612 JUL 613 ',$1,000,000 EACH OCCURRENCE A ERRORS AND OMMISSIONS I$2,000,000 ANNUAL AGGREGATE RETRO DATE: 07/0612007 DESCRIPTION OF OPERATIONSILOCATIONIVEHICLES/EXCLUSIONS ADDED ENDORSEMENT' SPECIAL PROVISIONS CONSULTING PROFESSIONAL THE CITY OF SANTA ANA ARE ADDED AS ADDITIONAL INSURED PER END CG 20 26 07 04. THE INSURANCE IS NON-CONTRIBUTORY AND PRIMARY END# L722 (02109) TO ALL OTHER INSURANCE OF THE CITY IN RESPECT TO THE OPERATIONS OF THE NAMED INSURED. 10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM CFRTIFICATF N(L nFR I I ADDITIONAL INSURED; INSURER LETTER: CANCFLLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT CITY OF SANTA ANA FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 20 CIVIC CENTER PLAZA, M-36 INSURER, IT; S AGENTS OR REPRESENTATIVES. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE A ' Y Y \ !�� Attention: MARILYN BOOTHE V ACORD 25 (2001108) Certificate # 12972 Mark Jackson 0673236