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'�� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE MVY)
<br />rypE OF INSURANCE
<br />11/1612012
<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 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 />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Marsh Risk & Insurance Services
<br />PHONE
<br />4695 MacArthur Court, Suite 700
<br />A/c No
<br />E -MAIL
<br />ADDRESS:
<br />(949) 399 -5800
<br />License 80437153
<br />MED EXP (Any one person)
<br />$ 5,000
<br />Newport Beach, CA 92660
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC p
<br />INSURERA: Philadelphia Indemnity Insurance Company
<br />18058
<br />093650- OSS- GAWX -12 -13
<br />INSURED
<br />Community SeelorSDry
<br />INSURER B: N/A
<br />N/A
<br />INSURER C :
<br />$ 1,000,000
<br />1200 N. knoll Circle
<br />Anaheim, CA 92801
<br />INSURER D:
<br />INSURER E:
<br />,.„ �rys0
<br />`�.y'
<br />e^ yn
<br />9 b,+ F(.)
<br />INSURER F :
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />COVERAGES CERTIFICATE NUMBER: LOS- 001530438 -02 REVISION NUMBER:3
<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 />INSR
<br />LTR
<br />rypE OF INSURANCE
<br />ADDLSUBR
<br />Santa Ana, CA 92701
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMMi
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />GENERALLIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I X I OCCUR
<br />John Graef
<br />PHPK888400
<br />07/01/2012
<br />07/01/2013
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMA ETO RENTED
<br />PREMISES Eaoccunends
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GENL AGGREGATE LIMIT APPLIES PE R:
<br />X POLICY mno LED
<br />PRODUCTS - COMP /OP AGO
<br />$ 3,000,000
<br />Sexual Misconduct
<br />$ 1,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />,.„ �rys0
<br />`�.y'
<br />e^ yn
<br />9 b,+ F(.)
<br />-
<br />qjj
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />BODILY INJURY (Per person)
<br />Is
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />( E,
<br />�-
<br />(a E
<br />_ "Fit,K e ~ -�
<br />-' "'
<br />��
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />DED RETENTION
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNER /EXECUTIVE❑
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory in Ni
<br />If yes, de scribe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />A55151dn { (�,1 �l
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<br />ryryry
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<br />WC STATU- OTH-
<br />E
<br />L. E. ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS) VEHICLES (Attach ACERB 101, Additional Remarks Schedule, If more space Is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers, and representatives are included as additional insured where required by written contract. This
<br />insurance is primary and non - contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance Services
<br />John Graef
<br />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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