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SPEGSER -01 MERCHANTAI ,a►►c�o�iz °° CERTIFICATE OF LIABILITY INSURANCE DATE 11 1 /13 /2 01 3 1 /1 312 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .PRODUCER CONTACT NAME: Willis Insurance Services of California, Inc. C/O 26 Century 81 Vd. P.O. Box 305191 Nashville, TN 37230 -5191 PHONE 877 945.7378 FAX (688) 467 -2376 AIC IN Ext : ( ) (AID, No E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: XL Specialty Insurance Company 37885 .INSURER B INSURED INSURER C Special Service for Groups INSURER D 605 W. Olympic Blvd., Suite 600 Los Angeles, CA 90015 INSURERS: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDLS INSR Me POLICY NUMBER POLICYEFF MMIDDIYYYY POLICY EXP MMIDDIVYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE ❑ OCCUR MED EXP(Any one person) PERSONAL B ADV INJURY _$ $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ $ POLICY JE� LOC__ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accitlent �_- BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accldent) $ NON -OWNED HIRED AUTOS AUTOS _ PROPERTY DAMAGE RACCIDE__ .(PE NT, $ $ UMBRELLA LIAB OCCUR CACI OCCURRCNCC $ AGGREGATE $ EXCESS LIAe CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE YIN OFFfCMandatory in ER EXCLUDED? Eeryln BER NIA _ RWD500028502 10/112013 10/1/2014 X WCSTATU- OTH TORY LIMITS ER - EL. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE $ 1,000,000 If yes, tlesAbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THIS CERTIFICATE VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED 912712013. D 0�� jk ,P1 1 L I LISA i��FcC'n sistanl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana, its officers, employees, agents, volunteers, AUTHORIZED REPRESENTATIVE and representatives Santa Ana Workforce Investment Board 1000 E. Santa Ana Blvd., Suite 200 0,6 Santa Ana CA 92701 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD names rI 1026d marks of ACORD