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ACORD, CERTIFICATE OF LIABILITY INSURANCE
<br />DATEIMMmOIYYYYI
<br />08/07/2013
<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 />REPRESENTATIVE OR PRODUCER,. AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: if the cortificato holder is an ADDITIONAL INSURED, the poiloyies) must be endorsed. If SUBROGATION IS WAIVED, sublact to
<br />the terms and conditions of the policy, curtail policies may require an endorsement. A statement on this certificate does not Condor rights to the
<br />certificate holder in Ilou of such endorsoment(s).
<br />PRODUCER
<br />Leavitt Group #OF13098"
<br />PrideMark-Everest Ins Sery Inc
<br />1820 E. First Street, Ste SOO
<br />Santa Ana, CA 92705
<br />CONTACT
<br />NAME;Juliana Bae
<br />_
<br />E
<br />AIC No ExIL 714.569.2700 x3817 —714.569.3099
<br />Ale, No,l_.-
<br />ADOaEBs: Julianaaa�bae@leavitt.com
<br />____ INSURERLS)AFPOROING COVERAGE _
<br />'—
<br />_
<br />NAICR
<br />INSURENA: Sentinel Ins Co, Ltd
<br />11000
<br />_
<br />INSURED OESMONO MARCELLO &AMS- TOS, LTC
<br />6060 CENTER DR #825
<br />INSURER e:
<br />I PREMISES Ee occurtenre)
<br />INSURER C:� �_•
<br />MED EXP (MY one person)
<br />LOS ANGELES, CA 90045
<br />INSURER D:�� �w _
<br />$ 1,000 00
<br />INSURER
<br />GENERAL AGGREGATE
<br />INSURER F:
<br />_
<br />GEN'LAGGRCGATE
<br />X POLICY
<br />DINET APPLIES PER'
<br />PRO.
<br />ECT LOC
<br />COVERAGES CERTIFICATE NUMBER: 2013-2014 GL/NOA/UMB REVISION NUMBER:
<br />THIS IS TO CERTlrYTHATTHE POLICIESINSURANCE D BELOW HAVE SEEN ISSUED TO THE MUM NAMED ABOVE R
<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 />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />,yNSSEXCLUSIONS
<br />LTRTYPE
<br />OP INSURANCE
<br />I ER
<br />WV
<br />POLICY NUMRER
<br />MMID WYYV
<br />POLICY EX?
<br />A1AUD0lYYYY
<br />I ._ LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIALGENEnAL LInmUTY
<br />CLAIMS MADE OCCUR
<br />City of Santa Ana AtnelEtanr
<br />20 Civic Center Plaza
<br />City Attorney
<br />72SBANM949E
<br />08/15/2013
<br />08116120141
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />I PREMISES Ee occurtenre)
<br />$ 300,00
<br />MED EXP (MY one person)
<br />S,10100
<br />PERSONAL A ADV INJURY
<br />$ 1,000 00
<br />GENERAL AGGREGATE
<br />-S 2.000,00
<br />_
<br />GEN'LAGGRCGATE
<br />X POLICY
<br />DINET APPLIES PER'
<br />PRO.
<br />ECT LOC
<br />PRODUCTS•COMP/GP ADD
<br />$ 2,000,00
<br />.$
<br />A
<br />AUTOMOBILE
<br />X
<br />__..
<br />LIABILITY
<br />ANYAUIG
<br />ALL OWNED _ SCHEDULED
<br />AUTOS AUTOS
<br />HIRE'O AUTOS X NOuro$ N -OWNED
<br />�_. D
<br />( 72SBANM949
<br />NO OWNED AUTO
<br />I
<br />tl8/1612013
<br />08!1512014
<br />Eo acddam ,r„ _v
<br />$ 1,000 00
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY(per aead
<br />S
<br />FRtlPFRTYGFM'AG
<br />,l?er acclaen, ..._ .__._-.
<br />$
<br />S
<br />A
<br />X
<br />uMaREuauns
<br />EXCESS UAB
<br />X
<br />OCCUR
<br />CIAIMS•MADE
<br />72SBANM949(
<br />0811512013
<br />08/15/2014
<br />EACHOCCURRENCF
<br />s 1,000, 0
<br />AGGRCGATE
<br />$ 1,000,00
<br />DED X RETENTION$ 10,00
<br />$
<br />W FUSSES COMPENSATION
<br />ANDEMPLOYERS'LIAeILITY
<br />ANY PROPRIETOMPARTNF.MXECUYIW, YIN
<br />OFPICERIMEMBRR EXCLOOED? ❑INIA
<br />IMandalarylnNH)
<br />1`//BP Oeacribonrodw
<br />DESCRIPTION OF OPERATIONS below
<br />TORY LIMITS ER
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<br />_
<br />E.L. EACH ACCIDENT
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<br />$
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<br />E,L DISEASE - FA EMPLOYEE
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<br />S
<br />E.1DISEASE-POLICYLIMIT
<br />$
<br />* *As required by written
<br />contract***
<br />OW
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is rugdmd)
<br />E: City Contract for Appraisal Services
<br />City of Santa Ana, its officers, employees, agents, volunteers & represen v�30�4red
<br />s respects general liability per SS 00 08 04 05, pgs 17-20, includes..ryr° aZn�rls e p69ory wording
<br />fin
<br />CERTIFICATE HOLDER ""X.`%v Ysa.0 r>_a t t J L'lUK (vi CANCELLATION
<br />©1008.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />-
<br />SHOULD ANY OF THE ADOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />f C C
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />1 -)Ufa
<br />�St; 5)Te,;dy
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana AtnelEtanr
<br />20 Civic Center Plaza
<br />City Attorney
<br />--
<br />AUTHORIZED REPRESENTATIVE
<br />M-25
<br />Sa to Arena, CA
<br />92701
<br />ga Well
<br />©1008.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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