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SENELSO.01 KLAUTER.IIING
<br />'`►coR® CERTIFICATE OF LIABILITY INSURANCE
<br />�---"'
<br />n 051007/201vvi
<br />07/201 1 8
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # 0757776
<br />C2�EEF, CT Adrianna Siqueiros
<br />HUB International Insurance Services Inc.
<br />P. O. Box 5345
<br />Riverside, CA 92517
<br />AIC N ;Eat: (951 779-8668 FAX 951 231-2572
<br />) ) /AIC, N.):(951)
<br />E.MNE . Cal.CPU@hubinternational.com
<br />ADDR
<br />INSURERS AFFORDING COVERAGE NAIC4
<br />INSURER A: The Travelers Indemnity Company of America 25666
<br />09/01/2017
<br />INSURED
<br />INSURER B: The Travelers Indemnity Company of Connecticut 25682
<br />INSURER C: Travelers Property Casualty Company of America 25674
<br />S. E. Nelson Construction, Inc.
<br />INSURER D:
<br />1240 East Ontario Avenue, 102.352
<br />Corona, CA 92881
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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 />/NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />INIC
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIOC
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X BVPD Ded: $5,000
<br />X
<br />DT229324B604TCT17
<br />09/01/2017
<br />09101/2018
<br />EACH OCCURRENCE $ 1'000,000
<br />DAMAGE TO RENTED 300,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any oneperson) $ 5,000
<br />PERSONAL a ADV INJURY $ 1'000'000
<br />GATLIMIT APPLIES PER:
<br />SEW AGGREXE
<br />I
<br />POLICY a jEL47 LOC
<br />GENERAL AGGREGATE $ 2'000'000
<br />PRODUCTS-COMPIOP AGG $ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Eg gacldentl
<br />_ _-
<br />BODILY INJURY per erson $
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY ALT 0p5
<br />BA9324B60417CNS
<br />09/01/2017
<br />09/01/2018
<br />BODILY INJURY Peraccldent $
<br />_
<br />P.rramd.n)t E $
<br />X
<br />ALKYDS ONLY X ATOS ONLY
<br />a
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE_ $ 9,000,000
<br />AGGREGATE $ 9,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CIJPBJ4214241726
<br />0910112017
<br />0910112018
<br />DED I X RETENTION$ 10,000
<br />Aggregate $
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />,W�FFICER%MEMggEERI EXCLUDED?]
<br />(Mandatoryin NH) -T
<br />If yes, describe under
<br />OH OPERAT,GNS below
<br />NIA
<br />DTJU69324B60417
<br />09/01/2017
<br />09101/2018
<br />Xt PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE-EAEMPLOYEE 5 1'000'000
<br />1,000,000DESCRIPTION
<br />E.L. DISEASE- POLICY Li,AT $
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES M CORD 101, Additional Remarks Schedule, mey be aU..hed If more space m re aired
<br />The City of Santa Ana, it's officers, employees, agents, and representative are Additional Insured's with regar� to lite General Liability policy when required by
<br />a written contract, per the attached endorsement form CG0247 08105.
<br />"Should the policies he cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any rights which may be
<br />afforded within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within thirty (30) days of
<br />the Cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub will provide to such certificate holder notice
<br />of such cancellation within ten (10) days of the cancellation date."
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016103) ©1988.2015 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 />City of Santa Ana
<br />Attn: Kathie Reyes
<br />THE ACCORDANCE WITH THE POLICY PROTION DATE VISIONSCE WILL BE DELIVERED IN
<br />220 S. Daisy, M-85
<br />Santa Ana, CA 92703
<br />AUTHORIZED REPRESENTATIVE ,
<br />r/ i 2t4'
<br />ACORD 25 (2016103) ©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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