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<br />POIICY Number, Date Entered: 05/0.
<br />CERTIFICATE OF LIABILITY INSURANCE I AisATE
<br />j.'Mi '
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TWI8
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
<br />the terms and conditions of the policy, contain
<br />PRQOUCER MICHAEL, GEFFRE INSURANCE AGENCY
<br />496 N. COAST HWY, SUITE A
<br />LAGUNA BEACH, CA 92651
<br />Ph: 949.494.7261
<br />INEU0.E0 TIREIA:N""8'OTOkiE$,Z'NC""h'4P'"FOTURRr
<br />3111 N TUSTIN
<br />SUITE 230
<br />ORANGE, CA 92865
<br />may roolre an Endorsement. A statement on this certificate does not confer rights to the
<br />94
<br />COVERAGES CERTIFICATE NUMBER, REvIRInN MI IMRER,
<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 SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS,
<br />EXTCLLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ORf v TYPE OF INSURANCE
<br />PO ICYNUM8ER�
<br />MMIDO
<br />M 10wmw
<br />LIMITS
<br />GeNERAL LIABILITY
<br />EACH OCCURRENCE $4,000,000
<br />A
<br />COMMERCIAL GENERAL LIABILITY
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<br />CLAIMSMADE —� OCCUR
<br />..__—.—._.w_._.,,..__..��._..__....
<br />SMP 6.391
<br />2/08/2012
<br />2/08/2013
<br />_E�AG��CR —� E 100I 000
<br />PREMISES (EM R7STn _
<br />MEKP(AnWv oneperson $S_, OOO
<br />RE
<br />PERSONAL 8, AOV INJURY_ $NOT COVERED
<br />GENERALAGGREGATE 84,000,000
<br />GENL AGGREGATE
<br />POLICY
<br />LIMIIT, APPLIES
<br />PR �r ��_
<br />PER:
<br />LOG
<br />PROOUCTB-COMPIOPAGO $NOT COVERED
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />LIMIT4,000,^ OOO
<br />Ee amident S4
<br />_,_ _ _
<br />BODILY INJURY (Per person) $
<br />—
<br />A
<br />ANYAUTO
<br />ALL OWNED F7 SCHEOULED
<br />AUTOS AUTOSf�--
<br />HIREOAUTOS AUUTOSWNEA
<br />SMP 6391
<br />2/08/2012
<br />2/08/2013PPReO-
<br />80014Y INJURY Per appidenl $
<br />( )
<br />no DAMAGE "
<br />�...�
<br />S
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LWB_
<br />_
<br />'CLAIMS.
<br />WADE
<br />DEO
<br />RGIGNTION $
<br />S
<br />s
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS! LIABILITY YIN
<br />ANY PROPRIETOR/PARTNERIEXECUTIVF.
<br />OFOURIMRNH) EXCLUDED4 �,.;
<br />N/A
<br />-
<br />EO1O7 91 31
<br />2)08/2013
<br />2/OB/201d
<br />WC TU- 0TH•
<br />T MT 5L____—,,._._.
<br />EL EACH ACCIDENT $1,000,000
<br />1,000
<br />E,L DISEASE -FA EMPLOYEE 8 600,000
<br />If es tlsscrldauMe,
<br />D CRIPTI�FOPBRATIONSHeIaw
<br />I
<br />�'-------- - —
<br />EL. DISEASE-POLICYLIMIT 51,000, ODD
<br />OBSCFtIPTION OP OPERATIONS I LOCATIONS / VEHICLES (Attnob ACORD 101,AddWoMl Rem &o 8oeodUlo, If more o ass fa re ulretl)
<br />THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA CA 92801; ITS OFFICERS, EMPLOYEES , AGENTS,
<br />VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH REGARD TO LIABILITY AND DEFENSE OF
<br />SUITS ARISING FROM THE OPERATIONS AND USES PERFORMED BY OR ON BEHALF OF THE NAMED INSURZ ,�,
<br />L�i?Pi�ta�ir-I) ��
<br />CERTIFICATE MOLDER I8 NAMED AS ADDITIONAL INSURED 11
<br />REK
<br />THE CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />O 1988-2010 A(
<br />4CORD 26 (2010105) The ACORD name and logo are registered marks of ACORD
<br />oduoed using Forma Moss Plus soltsmo. v .Fom,sflosacom; Impreselve publishing 6004WA977
<br />
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