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09/25/2012 11:39 3103489525 PAGE 02
<br />sac"R CERTIFICATE OF LIABILITY INSURANCE 9/23/2012
<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 cortlRcato holder Is an ADDITIONAL INSURED, the pollry(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the torma and conditions of tho policy, certain policies may require an endorsemCm. A statement an this c rtIfla to does not Confer rights to the
<br />certificate holder In Ileu of such endomament(a).
<br />PRODUCER NAME STEPHANIE ROCKWELL-MERCHANT
<br />-
<br />CAIQUO INSURANCE AGENCY P NE Y
<br />/VC NDEXIn 1310) 348--9936 fA,r;,NP1,(310) 34B°9525
<br />8939 3 Supulvada Blvd Ste 410 A'DRESS: rockwas 1 @ nationwide . Com
<br />Los Angeles, CA 90045 aveTD,MEBJPtEA40029790
<br />License#:040029790
<br /> MSURER(A AFFORDING COVERAGE NA106
<br />INSURED ARC MID CITIES INSURERA?PHILADELPHIA INDEMNITY INS, CO 18058
<br /> INSURER a ?
<br />14208 Towne Avenue INSURER C:
<br />Los Angeles, CA 90061-2653 INSURER D:
<br /> INSURER E :
<br /> INSURER F
<br />COVERAGES CERTIFICATE NUMBER:ARCM101a REVISION NUMBER:
<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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />I?IF TYPE OF INSURANCE
<br />INSR
<br />woo
<br />POLICY NUMBER
<br />M / U
<br />MIwOOY rffYY) LAP
<br />LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
<br /> GOMMF.RCIAI. GENERAL LIABILITY PREMISES Ea onCUrconEd S 100 , 000
<br /> CLAIMS-MADE CI oCCUR MED VP (Any one person) S 5 , 000
<br />A PHPK896661 7/19/2012 7/19/2013 PERSONAL d ADV INJURY S / /
<br /> GENERAL AGGREGATE Il 1000 /
<br /> COWL AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMPIOP AGO
<br />/
<br />777
<br />
<br />I PRO LOr
<br />POLICY
<br />F
<br />$
<br /> AUT _ _
<br />OMOBILE LIABILITY COMBINED $INGL@ LIMIT
<br />$
<br /> - (En Accident)
<br /> ANYAUTO 90DILY INJURY (Per perm) S
<br />
<br />A ALL OWNED AUTOS
<br />PHPKB24273
<br />9/23/2012
<br />9/23/2013 DODILY INJURY (Per epddanl) D 2,000,000
<br />. _ SCHEDULED AUTOS PROPERTY DAMAGE S
<br /> 8 HIRED AUTOS IPnr AccldAnl)
<br /> X NON-OWNED AUTOS $
<br /> 3
<br /> }( UMBRELLA LIAR x OCCUR EACH OCCURRENCE $ 2,000,000
<br />p EXCESS LIAB CLAIMS-MADE PHUS390722 07/19/2012 07/19/2013
<br />AGGREGATE
<br />'F
<br /> DEDUCTIBLE APPROVED AS 0 BJ. - - $
<br />
<br /> RETENTION $ $
<br /> WO RKERS COMPENSATION
<br />' T OV LIM TS OIH-
<br /> LIABILITY
<br />AND EMPLOYERS
<br />YIN
<br /> E /F?(RCVTIVB
<br />ANY PRb P .. E. L. EACH ACCIDENT
<br /> NOER
<br />DER EXCLUDED? ? N/A dUCtl ?(' C SI
<br />L bedY
<br /> onr10
<br />ftnd
<br />IMnedMOry In NHI .
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br /> Ifyc9 tloocrlba under
<br />DESGrRIPTION Or OPERATIONS below A,SS1SUARL City ttOraCJ
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br /> 1.)1?ROLnE83SONAL ABILITY PHPK696661 /19/2012 -7/19/2013 $3,000,000
<br />A 2,)SEXUAL MISCONDUCT PHPK896661 7/19/2012 7/19/2013 $1,000,000/$2,000,000
<br />DESCRIPTION Or OPERATIONS / LOCATIONS ( VEHICLES (Attach ACORD 101, Addlllpnal Remark, Schodule, If more apace Is requlrad)
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES
<br />ARENAMEDAS ADDITIONAL INSURED($).KAIVER OF SUBROGATION IS IN FAVOR OF THE CITY OF SANTA ANA,
<br />ITS OFFICERS, EMPLOYEES, AGENTS, AND THEIR RESPECTIVE INSURERS.
<br />CERTIFICATE HOLDER CANCELLATION
<br />
<br />CITY OF SANTA ANA SHOULD ANY OF TILE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />220 S. DAISY AVENUE TH EXPI ION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA, CA. 9270 •' ACCO ANDE TH THE POLICY PROVISIONS,
<br />DANELL MERCADO
<br /> AUTHORI2 REPRP,SE ATIVR
<br />-- - ®1988-2009 ACORD CORPORATION, All rights reserved.
<br />ACORD25(2009/09) The ACORD name and logo are registered marks of ACORD
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