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<br />.�cta�e * CERTIFICATE OF LIABILITY INSURANCE °oe;�9 aoi4'�
<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.
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<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(lea) must be endorsed, if SUBROGATION IS WAIVED, subject to
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<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
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<br />certificate holder in lieu of such andorsement(s).
<br />WIS -TR- 0022460 ^11
<br />PRODUCER 0726293 1- 415 -546 -9300
<br />CONTACT
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<br />Arthur J. Gallagher &'CO.
<br />NAME;
<br />PHONE _ _.. TPA%
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<br />insurance Brokers of California, Inc., License #0726293
<br />INS No "WIL. INC, Ng; .
<br />_ - - -- --
<br />125S Battery Street #450
<br />E-MAIL
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<br />CLAIMSAIADE L X OCCUR
<br />ADDRESS : - . .. _. ._. 1 _.
<br />San Francisco, CA 94111
<br />__ __ INSURER(5) AFFORDING COVERAGE NAICM
<br />$ 5, 000
<br />Loan6 Le _ _. .. _...
<br />INSURERA: AMERICAN ALT INS COUP ;19720
<br />__._ .. ...
<br />INSURED
<br />INSURERB: ARGONAUT INS CO 119801...
<br />PERSONAL&ADVINJURY
<br />Orange County Fire Authority
<br />_SIR
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<br />1 Fire Authority Road
<br />Twine, CA 92602
<br />COVFRAGFR CFRTIFHcATF NIIMRFR• 41070934 RFVISIAM MIIMHFO.
<br />THIS IS f0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO i'HE 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 />INS %� AHer SUBRF
<br />b ....- POLICYNUMBER IMMAKIN I PDLICVE #P - I
<br />TR TYPE OF INSURANCE : I (POLICYYYYI LIMITS
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<br />GENERAL LIABILITY �T
<br />WIS -TR- 0022460 ^11
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<br />07/01/ 15;
<br />EACH OCCURRENCE
<br />51,000,000
<br />I USA
<br />!X COMMERCIAL GENERALLIABILITY
<br />IbAMMI E TO RENTED
<br />8 1,000,000
<br />-.,
<br />CLAIMSAIADE L X OCCUR
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<br />PREMI$E$1Ee occhvencel ..
<br />MED EXP (Any one person)
<br />$ 5, 000
<br />`8 $0
<br />PERSONAL&ADVINJURY
<br />I$1, 000, 000
<br />_SIR
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<br />!
<br />GENERAL AGGREGATE ,.�$
<br />2, 000, OOtl
<br />OENLAGGREOATE LIMITAPPLIE9 PER:
<br />PRODUCTS COMPIOPAGG
<br />$ 21000,000
<br />X POLICY PRO, LOC
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<br />!
<br />5
<br />AUTOMOBILE LIABILITY
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<br />—T
<br />COMBINED SINGLE —LIMIT
<br />(EaacOdeA)
<br />'�-
<br />ANY AUTO
<br />1
<br />UODILY INJURY (Pe, person)
<br />• $
<br />, AM OWNED -- SCHEDULED
<br />.;AUTOS __IAUTOS
<br />BODILY INJURY ( P seeder n)
<br />r$
<br />! NONUWNED
<br />HIREDAVTO5 ..I AU ITS
<br />I PROPERTY DAMAGE j$
<br />(P ar A4ident)
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<br />IX UMBRELLA LIAR X_�
<br />Rb2- 44627336 -02
<br />07/01/1&11
<br />07/01/15
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAB CLAIMSWADE
<br />AGGREGATE
<br />20,000,000
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<br />DEB 'X I RETENTION$ 0
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIA9ILRY YIN
<br />�WC STATU OTH
<br />, .T4RY AMTS LR.;.
<br />_.
<br />ANY PROPRIETORIPARTNERIEXECLINVE
<br />EL EACH ACCIpENT
<br />1$
<br />OFFICEWMEMBER EXCLUDED? NIA
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<br />NAmm mV In NH)
<br />i E L DISEASE EA EMPLOYEE
<br />$
<br />B YYar, describe under
<br />[OESORIPTIONOF OPERATIONS belms
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<br />!
<br />IEL. DISEASE - POLICY LIMIT'$
<br />5�Y
<br />DESCRIPTION OF OPEMTIONSI LOCATION$ IVEHICLES (Aaach ACORD 101, Addfilonal Romano Schedule, It more apace is required)
<br />RE: CCFA remodeling Santa Ana fire stations
<br />- OCFATS insurance will be primary with reapoot to insurance or self- insurance program maintained by the City of Santa
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<br />"The Producer will endeavor to mail 30 daye written notice to the Certificate Holder named on the certificate if any
<br />policy lined on the certificate is cancelled prior to the expiration date. Failure to do so shall impose no obligation
<br />or liability of any kind upon the Producer or otherwise alter the policy terms
<br />�Y3e]4PoBL�Y�MAIIiIYe ., e..
<br />O 1900.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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<br />41070934
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Community Devalopment Agency
<br />THE EXPIRATION DATE 'THEREOF, NOTICE WILL BE DELIVERED IN
<br />Adminiatrative Services Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Sylvia Vaaguez, Management Analyst
<br />20 Civic Center Plaza, X-25
<br />AUTHORIZED REPRESENTATIVE^r,
<br />Santa Ana, CA 92701
<br />71"(OLr
<br />I USA
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<br />O 1900.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />rgreen
<br />41070934
<br />
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