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ACOR/, CERTIFICATE OF LIABILITY INSURANCE
<br />4M
<br />DATEIMMIDDM'VN)
<br />06/25/2014
<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 />Mutual Insurance Agency
<br />CA License # 0574081
<br />30 N. Marengo Ave
<br />Pasadena, CA 91101
<br />CONTACT
<br />NAME:
<br />aC °No Ex, 626.795.9595 (AIC,Na1626.793.7864
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />iNSURERA: American States Ins Co
<br />19704
<br />INSURED MDG Associates, Inc.
<br />10722 Arrow Route, Suite 822
<br />Rancho Cucamonga, CA 91730
<br />INSURERS:
<br />07101/2014
<br />INSURER C:
<br />EACH OCCURREM1ICE
<br />INSURER D:
<br />PREMISES (Ea occurrence)
<br />INSURER E :
<br />MED EXP (Any one person)
<br />INSURER F:
<br />PERSONAL & ADV INJURY
<br />COVERAGES CERTIFICATE NUMBER: 2014 -2015 GL, Auto, Umb .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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />(MMIDDPlVYV)
<br />(MMID�rYYYY)
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX� OCCUR
<br />X.
<br />Sa to Ana, CA 92701
<br />01CH0671480
<br />07101/2014
<br />07/01/2015
<br />EACH OCCURREM1ICE
<br />$ 1,000,.000
<br />PREMISES (Ea occurrence)
<br />$ 200,000
<br />MED EXP (Any one person)
<br />$ 10,00
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000.,000
<br />GENT, AGGREGATE LIMIT APPLIES PER
<br />POLICY M PRO-
<br />JECT F7 LOC
<br />PRODUCTS - COMP/OP .AGG
<br />$ 2,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />AUTOS NED AUTOS SCEDULED X
<br />HIREDAUTOS X AUTOSWNED
<br />OICI7007353
<br />07/01/2014
<br />07/01/2015
<br />Ea eco7dent)
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />(Per accident) o
<br />$
<br />A
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />01XS1499179
<br />07/0112014
<br />07/01/2015
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />X
<br />AGGREGATE
<br />$ 4,000,000
<br />DED I X I RETENTION $ 10, OO
<br />$
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS`LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH).
<br />DIf yes, describe under
<br />ESCRIPTION OF OPERATIONS below
<br />NIA
<br />n
<br />PP
<br />WCSI A I J- OTH-
<br />TORY LIMITS ER
<br />EACHACCIDENT
<br />_ - P
<br />DI ASE - POLICY LIMIT
<br />$
<br />enior Assistant
<br />ose a Va
<br />City Attorney
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is re Jred)
<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 CG0001 attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010 /05)
<br />O 1988 -2010 ACORD CORPORATION. All rights reserved,
<br />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 />Attn: Terri Eggers, Senior Mgmt. Analyst
<br />20 Civic Center Plaza
<br />% 1
<br />Sa to Ana, CA 92701
<br />Howard Wooton/TLL
<br />ACORD 25 (2010 /05)
<br />O 1988 -2010 ACORD CORPORATION. All rights reserved,
<br />The ACORD name and logo are registered marks of ACORD
<br />
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