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Client#: 574120 SURETRAC ACORDTM CERTIFICATE OF LIABILITY INSURANCE D ( 1 VWY) ATE MM 61 01a os no12 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 an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Emily Silversparre JNAME' Hub International ' PHONE 877 825.2681 951 231-2572 AIG, I Ext : AIC, Nc HUB Int I Insurance Serv. Inc. Cal CPU@hubinlernational com A DRIE - . D SS: 180 N Riverview Dr, Ste 170 I COVERAGE INSURER(S) NAG # Anaheim, CA 92808 E l G ld l l C I ag ncur e ag o en e nsurance ce orporat INSURERA: 10836 INSURED INSURER B: Peerless Indemnity Insurance Co 18333 Sure Track, LLC INSURER C: 3130 S. Harbor Boulevard, Suite 100 INSURER D: Santa Ana, CA 92704 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. ILTftR TYPE OF INSURANCE NADDL SR WSUBR VD POLICY NUMBER MMIDDNYYY MM/DDIYYVYY LIMITS A GENERAL LIABILITY BOP3084B09 0312612013 031261201 EACH OCCURRENCE $110001000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $50,000 CLAIMS-MADE ®OCCUR yy(r gg'?VA MED EXP(Any one person) $5,000 +Q 15 LL°° PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000 PRO- POLICY LOC JECT $ AUTOMOBILE LIABILITY t^ ? n? (i01 C COMBINED SINGLE LIMIT P. accident ANY AUTO .,.I BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS a A Sts?a BODILY INJURY (Peramldent $ WNE? d"S ? OAMAGE PROPERTY $ HIRED AUTOS AUTOS P ... d (Per nt y J $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEG RETENTION $ $ B WORKERS COMPENSATION WC3084810 0312612013 03/261201 X WC STATU- OTH- AND EMPLOYERS' LIABILITY ?L MI 5 ER YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $1,000,000 LN] (Mardatcry in Ni E.L. DISEASE ?E $1,000,000 , describe DEC ON OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1 000,000 I T , I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD Ii Adddional Remarks Schedule, if more space is required) The City of Santa Ana, its officers, employees, agents & representatives are Additional Insured in regard to General Liability per the attached endorsement form 44-148 06/04; Primary and Non-Contributory wording applies per the attached endorsement form 44-231 07/10. The City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) 1 of 1 #S2267723/M2240142 @ 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Exhibit C MG42