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CERTIFICATE OF LIABILITY INSURANCE
<br />IDD
<br />DATE/21/2013
<br />111 /21/21/2001313
<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(les) 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 />MOC Insurance $erV1Ce5
<br />License No. 0589960
<br />44 Montgomery St., 17th Fl.
<br />San Francisco CA 94104
<br />CONTACT Halides, Calle J as
<br />NAME:
<br />PHONE (415)957-06)00 I 1X
<br />FAC No:(415)957-0577
<br />gbmAgIESJS,hcallejas@mocins. corn
<br />INSURERS AFFORDING COVERAGE NAICN
<br />INSURERA;Golden Eagle Insurance Corp 10836
<br />INSURED
<br />Keyser Marston Associates, Inc.
<br />160 Pacific Avenue, Suite 204
<br />San Francisco CA 94111
<br />INSURER B:Re ublic Indemnity Company 22179
<br />INSURER C:Evans ton Insurance Cc 35378
<br />INSU RER D;
<br />INSURER E:
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:IAASTER 2013-2014 REVISION NUMBER:
<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 />DDLSUGR
<br />POLICY NUMBER
<br />POLICY EFF
<br />flMMdDDNYYY1
<br />POLICY EXP
<br />MMIDDIYYYYI
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />131?8932329
<br />12/1/2013
<br />12/1/2014
<br />PREMISES OEaoccurance $ 500,000
<br />MED EXP(Any one person) $ 10,000
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />o Deductible applies
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN1 AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG $ 1,000,000
<br />POLICY
<br />RO LOC
<br />X PECT
<br />$
<br />COMBINED SINGLE LIMIT
<br />Ea accident $ 1,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />BODILY INJURY (Per person) $
<br />A
<br />X
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NOOTOSWNED
<br />X
<br />8932429
<br />12/1/2013
<br />I 13
<br />12/1/2014
<br />BODILY INJURY (Per accident) $
<br />(Per TY DAMAGE $
<br />®D/E
<br />Uninsured motorist combined $ 1.000,000
<br />X
<br />Come $500 X Call $500
<br />v
<br />■f,
<br />X
<br />UMBRELLA LIAR
<br />OCCUR
<br />fy
<br />orney
<br />EACH OCCURRENCE$ 9 , 000, 000
<br />AGGREGATE $ 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION$ 10,00C
<br />$
<br />X
<br />2u 8932629
<br />12/1/2013
<br />12/1/2014
<br />B
<br />WORKERS COMPENSATION
<br />X WCSTATU- I OTH-
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />03959619
<br />12/1/2013
<br />12/1/2014
<br />EL EACH ACCIDENT $ 1,000,000
<br />(Mandatory In NH(
<br />E.L DISEASE -EA EMPLOYE $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT $ 1.000,000
<br />C
<br />Professional Liability
<br />0855446
<br />12/1/2013
<br />12/1/2014
<br />Each Wrongful Act $1,000,000
<br />Retention: $25,000
<br />AGGREGATE LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORO 101, Additional Remarks Schedule, if more space is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any
<br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<br />iL,JrPF6I
<br />City of Santa Ana
<br />Executive Director of PBA
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ncnr9n 2F r2n1nmsl
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Callejas/HCA "° -� -'
<br />OlIf:I:F:blRiffL•�KKN�IK�]:FIK:7e\ifi7. �RRlItS7:17�17s1
<br />INSG25 (201005).01 The ACORD name and logo are registered marks of ACORD
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