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<br />-A-CORD, CERTIFICATE OF LIABILITY INSUkANCE
<br />DATE (MMIDDNYYY)
<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 riahts to the
<br />certificate holder in lieu of such endorsement(s)
<br />PRODUCER CONTACT
<br />NAME:
<br />Mutual Insurance Agency PHONE 626,795.9595 FAX 626.793.7864
<br />IC C a E#
<br />A __ INC , Noll
<br />CA License # 0574081 E -MAIL
<br />ADDRESS:
<br />30 N. Marengo Ave INSURER(S) AFFORDING COVERAGE NAIC#
<br />Pasadena, CA 91101 INSURER A: American States Ins Co 19704
<br />INSURED MDG Associates, Inc. INSURER
<br />10722 Arrow Route, Suite 822 INSURER C: _
<br />Rancho Cucamonga, CA 91730 INSURER D:
<br />COVERAGES CERTIFICATE NUMBER: 2013 -2014 CL Auto. UmH RFVIRION 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />0
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYVY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />Santa Ana, CA 92701
<br />GENERAL LIABILITY
<br />01CH0671489C
<br />07/01/2013
<br />07/01/2014
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE F1171
<br />A I OCCUR
<br />PREMISES(Eaoc.mmrce)
<br />$ 200,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />A
<br />X
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEPIERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LI MIT T APPLIES PER
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />POLICY PRE C LOC
<br />C
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />OICIIO01112
<br />07/01/2013
<br />07/01/2014
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />A
<br />_
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />-NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />X
<br />BODI LVINJURY Per accident
<br />I I
<br />t
<br />�r26PERT9LA�lAO�
<br />-Par accident_
<br />UMBRELLALIAB -
<br />X
<br />occuR
<br />OIX51499178'
<br />07101/2013
<br />07/01/2014
<br />EACH OCCURRENCE
<br />S 4,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />��yy
<br />i� yf
<br />j��
<br />"'
<br />AGGREGATE
<br />$ 4,000,000
<br />OLD X I RETENTION $ 10, 00
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVFD
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />y^��p
<br />yq T''iJ'5„/ X°�' /A
<br />d'+L r 4 rY
<br />1,
<br />�,,,,..
<br />�
<br />W - OTH-
<br />TORY LIMITS ER
<br />E. L. EACH ACCIDENT
<br />$
<br />E.L, DISEASE - EA EMPLOYE
<br />$
<br />(Mandatory In NH)-
<br />If yes, describe under
<br />DE8 RIPTION OF OPERATIONS below
<br />-°
<br />SP`
<br />��4(
<br />} me
<br />E. L. DISEASE - POLICY LIMIT
<br />$
<br />Pssi,tani '
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is req u l red)
<br />The City of Santa Ana, its officers, employees, agents and volunteers are named Additional Insured,
<br />but only as respects the Insureds Operations as it relates to their Signed Contract in regards to the
<br />CDBG Administration Consulting Services per Form CG8674 attached. Primary Insurance and
<br />Transfer of Rights of Recovery Against Others is included per Form C00001 attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />U 1988 -ZU10 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Community Development Agency
<br />AUTHORIZED REPRESENTATIVE
<br />�
<br />Attn: Terri Eggers, Senior Mgmt. Analyst
<br />20 Civic Center Plaza ..
<br />Santa Ana, CA 92701
<br />Paul Wooton /TLL
<br />U 1988 -ZU10 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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