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DATE
<br />coR['7® CERTIFICATE OF LIABILITY INSURANCE 1/23/2013�
<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 />PRODUCER NAME:. Amy Alberding
<br />SPIB Insurance Agency, Inc. PHONE (949) 5 8 2 - 5 2 2 0 PAX
<br />A/C No(949)582-3512
<br />License Number 0719264 E-MAILBESS.amy(4spib.Cost
<br />26441 Crown Valley Parkway#200 INSURER(S) AFFORDING COVERAGE NAICN
<br />Mission Viejo CA 92691 INSURER A -Peerless Insurance Co 24198
<br />INSURED INSURERS The Netherlands Insurance Co 24171
<br />Rue Vac Property Services Inc INSURERC:Golden Eagle Insurance Corp. 10836
<br />600 W. Taft Avenue INSURERD:State Comp Insurance Fund 210
<br />CA 92865
<br />r71VFRAOF¢ r1FRTIFIr`ATF NIINARPP-2MSTR13-14WC-GL-A-U-P RFVIRIr1N 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 />I
<br />LTR
<br />TYPE OF INSURANCEluuvm
<br />ADULSUNH
<br />POLICY NUMBER
<br />MWODNYVV
<br />POLICY EXP
<br />MWDDNYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1, 000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE RENTED
<br />PREMISES OEaoccurence
<br />$ 100, 000
<br />A
<br />CLAIMS -MADE FxIOCCUR
<br />CBP9558563
<br />2/1/2013
<br />/1/2014
<br />MED EXP(Anyone parson)
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1, 000,000
<br />GENERAL AGGREGATE
<br />$ 2, 000,000
<br />AGGREGATELIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2, 000,000
<br />$
<br />_GEL
<br />X POLICY PRO LOG
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1 000 000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BA9797086
<br />2/1/2013
<br />/1/2014
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY
<br />(Per eiet
<br />$HIREDAUTOS
<br />X NON -OWNED
<br />XAUO
<br />Underinsured motorist propery
<br />$
<br />X COMP PER SCH X COLL PER SCH
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000, 000
<br />X
<br />AGGREGATE
<br />$ 11000, 000
<br />L.
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />1
<br />$
<br />CU9558863
<br />/1/2013
<br />/1/2014
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY PROPRIETORIPARTNER/EXECUTIVE E
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />9038319-13
<br />1/1/2013
<br />1/1/2014
<br />X I WC STATU- OTH-
<br />LIMITS PH
<br />EL EACH ACCIDENT
<br />$ 1,000, 000
<br />'
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1, 000, 000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />PROPERTY, SPECIAL FORM
<br />CBP9558563
<br />/1/2013
<br />/1/2014
<br />BUILDING 1,248,480
<br />REPL COST $1000 DED
<br />BUSINESS PERS PROPERTY 104,040
<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 />,j )'ROVLll AS TO FORK;
<br />..aura St al Veedy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />A �n rvta rtf S"itV AtLo'UCi 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 />IL Hines, CPCU ARM CLU�-
<br />ACORD 25 12010/05) © 1988-2010 ACORD CORPORATION. All rights reserved.
<br />INS025 (201005) 01 The ACORD name and Joao are registered marks of ACORD
<br />
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