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D ESMO-1 OP ID: AM
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />D/1
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />'YYj
<br />1,106120/3
<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: Steven L Monteith
<br />John J. MatsOCk Assoc. Inc.
<br />1750 N Washington Street
<br />J FAX
<br />A"rcNrd . EXt1.530-505 7335..__._
<br />E-MAIL
<br />ADDRESS:
<br />Naperville, IL 60563
<br />Steven L. Monteith
<br />EACH OCCURRENCE
<br />INSURER(P)AFFORDING COVERAGE
<br />NAEC N
<br />X
<br />INSURER A: Bt Paul Travelers - AMD
<br />25674
<br />INSURED Donna Desmond Associates. �
<br />INSURER 8:
<br />1210112013
<br />65 South Beverly Olen Blvd.
<br />ITi vt T RENTED
<br />�_PERk�
<br />MED EXP (Any persona
<br />300,00
<br />$ 10,00
<br />Los Angeles, CA 90024
<br />INSURER C.
<br />$ 1,000,00
<br />INSURER D
<br />INSURER. E
<br />INSURER F:
<br />$ 2,000,00
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICI'LS 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 />ADDU
<br />UB
<br />r
<br />POLXCY NUMBER
<br />POLICY ESE_...
<br />MMIDD/YYYY
<br />f'OL.ICY EXP
<br />MMIDDFYYYY
<br />LIMITS..
<br />20 CIVIC CENTER PLAZA M-36
<br />GENERAL.
<br />LIABILITY
<br />EACH OCCURRENCE
<br />$ 1.,000,00
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />680-18716605
<br />1210112013
<br />1 z1a112a14
<br />ITi vt T RENTED
<br />�_PERk�
<br />MED EXP (Any persona
<br />300,00
<br />$ 10,00
<br />-ane
<br />PERSONAL F ADV INJURY
<br />$ 1,000,00
<br />'.. GENERAL AGGREGATE
<br />$ 2,000,00
<br />_
<br />GEN`L AGGREGATE LIMIT APPLIES PER.m. ..._
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,00
<br />POLICY 0PRO Loc
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,aaa,o,a
<br />BODILY INJURY (Per person)
<br />s
<br />AANY
<br />AUTO
<br />680-1 B716605
<br />12101/2013
<br />1210112014
<br />_X
<br />l
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accidenij
<br />$
<br />NON-OWNED
<br />HIRED AUTOS LxAUTOS
<br />PROPERTY DAMAGE
<br />PER ACCIDENT
<br />$
<br />�$
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />[_d
<br />OCCUR
<br />CLAIMS-MADE�
<br />u
<br />1 �'W"„ p
<br />,. a) Lt°o- �'
<br />�a
<br />EACH OCCURRENCE
<br />ii $
<br />e—
<br />AGGREGATE
<br />ii,, $
<br />DED RETCNT'14hY.5
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIFTORIPARTNrRIEXECUUVF
<br />Oi"FICER1MEr+IUER ER EXCLUDED? .
<br />(Mandatory In
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<br />WC STATU- OTH-
<br />RY LIMn"SR
<br />L EACH ACCIDENT
<br />$
<br />N `
<br />.L. DISEASE - EA EMPLOYEE
<br />$
<br />If' yes. describe under
<br />m._..__................_.e._.-._._.._.,�.
<br />DESCRIPTION OF OPERATIONS befow
<br />E.A. DISEASE - POUCY LIWT
<br />$
<br />A
<br />Property Section
<br />T[I
<br />680-1 B716605
<br />1210112015
<br />1210112014
<br />DESCRIPTION OF OPERATIONS I LOCATIONS C VEHICLES (Attach ACORD 1.01, Additional Rernarhs Schedule, it more space is requl.red)
<br />ADDITIONAL INSURED WITH RESPECTS TO GENF-PAL LIABILITY; CITY OF
<br />SANTA ANNA,ITS OFFICERS, EMPLOYEES, AGENT'S, VOLUTEERS AND
<br />REPRESENTATIVES//ADDITIONAL INSURED IS PRIMARY AND NON
<br />CONTRIBUTORY//AS REQUIRED BY WRITTEN CONTRACT, CERTIFICATES
<br />ARE SUBJECT TO ALL POLICY TERMS AND CONDITIONS.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SANTAAN
<br />SHOULD ANY OF THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY' PROVISIONS.
<br />PUBLIC WORKSAGENCY
<br />ATTN: JASON GABRIEL
<br />20 CIVIC CENTER PLAZA M-36
<br />AUTHORIZED REPRESENTATIVE
<br />s�rx
<br />SANTA ANNA, CA 92701
<br />ACORD 2,5 (2010105)
<br />Ca 1988-2.010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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