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kC° ° CERTIFICATE OF LIABILITY INSURANCE <br />1++. -° - "' <br />D1311IDO/YYYYI <br />7/31/2014 <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(&), 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 condition 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 />ACT Panla Pepe ...- ....... <br />Insurance Solutions <br />License #074653^T <br />9 <br />33302 Valle Rd, Suite 200 <br />San Juan Capistrano CA 92675 <br />PiloN F <br />p4 p t,. (949)348-7400 Ix � N p (9491348 -2973 <br />.Paula? @ins- sclutions.com <br />INSURER(SI AFFORDING COVERAGE <br />NAICN <br />INSURERA0entin0l Ins Co. , LTD <br />11000 <br />INSURED <br />INSURERS .Twin City Fire Ins Co <br />29459 <br />PELLETIER & ASSOCIATES INC <br />INSURERCMOUnt Vernon Fire Ina CompaR <br />26522 <br />INSURERO: <br />PC BOX 368 <br />INSURERS: <br />LAKE FOREST CA 92609 <br />INSURER F: <br />ATAAGETGRENTED"' —' <br />P I. sa <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 />�T <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POlDrPY, <br />N Y <br />POU Y X <br />LIMITS <br />GENERAL LIABILITY <br />.Wf <br />EACH OCCURRENCE <br />S 1,000,000 <br />X COMMERCIALGENERALIJABIL1TY <br />ATAAGETGRENTED"' —' <br />P I. sa <br />1,000, 000 <br />A <br />CLAIMS -MADE OCCUR. <br />72SBAIF97595 <br />9/1/2014 <br />8/1/2015 <br />_S <br />S 10,000 <br />MED EXP (An ane er9on <br />PERSONAL ADV INJURY <br />_ <br />$ LL 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GENL AGGREGATE LIMITAPPUES PER: <br />PRODUCTS -COMPIOPAGG <br />$ 2,000,000 <br />X I POLICY PRO. LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMB ED5114GLELIMiT <br />d <br />$ 1 000 000 <br />BODILY INJURY(Perpomm) <br />$ <br />A <br />ANY AUTO <br />ALLOWNEO SCHEDULED <br />AUTOS AUT09 <br />72SBAIT7595 .8/1/2014 <br />0/1/2015 <br />BODILY INJURY Pwaoddanl <br />I 1 <br />$ ._.. <br />X <br />HIREDAUTOS X AUTOS�Etl <br />y. <br />PeOeioRin. enlDAMAGE <br />$ <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAR <br />.CLAIMS -MADE <br />AGGREGATE <br />$ <br />OED I I RETENTION$ <br />$ <br />_ <br />B <br />WORKERS COMPENSATION <br />® - -w- <br />VVI' 9TATU- O <br />Y <br />AND EMPLOYERS' LIABILITY YIN <br />'QL MMliS'— <br />_ <br />EL.EACH ACCIDENT. <br />S :1 1000 000 <br />ANY PROPRIETORIPARTNEIVEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(MmdI In NH) <br />NIA <br />12WECLP3277 <br />0/1/2014 <br />/1/2015 <br />E.L. DISEASE - EA EMPLOYE' <br />S 1 000 000 <br />deso <br />E.L. DISEASE - POLICY LIMIT <br />$ IL0OOO 000 <br />_es. <br />OE0yeOFO PERATIONS below <br />CR$PTI ON N OF O <br />C <br />Errors & Omissions <br />SP2009690E <br />3/1/2014 <br />B/1/2015 <br />Limit:$ 2,000,C00 <br />Dedwilbl 1$ 1,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUaeh ACORD 101, AddRlonal Remarks Schedule, If mom spars Is raqulmd) <br />City of Santa Ana, 20 Civic Center Plaza, California 92701; its officers, am sea, agents, volunteers <br />and representatives are named as additional insured per the Business +i4�a$ AOF0SF"RM <br />attached to the policy. Coverage is Primary per attached endorsement. YYia .ev <br />Joseph Straka <br />BMorales5@santa–ana.org 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 ACCORDANCE WITH THE POLICY PROVISIONS, <br />Attn: Risk Management, M28 <br />20 Civic Center Plaza AUTHORISED REPRESENTATIVE - <br />Santa Ana, CA 92702 <br />ACORD 25 (2010106) <br />Alessandra /PETERS z"°'^'-9 <br />©1988.2010 ACORD CORPORATION, All riGhts <br />INSU25 r?010nR101 Thu ACnRn aamn and Inn. u. mniafnaad marlrn of Ar.nRn <br />