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4ctaizv® CERTIFICATE OF LIABILITY INSURANCE <br />�...-'' <br />DATE312512D/YYYV) <br />3/25/2019 <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 Patriot Risk & Insurance Services <br />2415 Campus Drive, Suite #200 <br />Irvine, CA 92612 <br />CONTACT <br />PHONE MIG. No. Ext)949 486-7900 ac No: 949 486-7950 <br />EMAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC# <br />3/23/2019 <br />INSURERA: Everest National Insurance Company 10120 <br />www.patrisk.com OK07568 <br />INSURED <br />Butler Chemicals, Inc. <br />3070 E. Ceena Court <br />INSURER B: Everest Indemnity Insurance Company 10851 <br />INSURER C: <br />INSURER D: <br />Anaheim CA 92806 <br />INSURER E <br />PRODUCTS - COMP/OP AGO $2000000 <br />INSURER F: <br />B <br />COVERAGES CERTIFICATE NUMBER: 47705748 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 />ADDLSUBR <br />INSD <br />WVO <br />POLICY NUMBER <br />POLICY EFF <br />flMMIDDNYYN1 <br />POLICY EXP <br />IMINI <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE. FZ OCCUR <br />CF101-00211191 <br />3/23/2019 <br />3/23/2020 <br />EACHOCCURRENCE $1000000 <br />PREMISES ( a occurrance) $100,000 <br />MED EXP (Any one person) $15,000 <br />PERSONAL & ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICVF,—/ ]JEC LOC <br />OTHER: <br />GENERALAGGREGATE $2,000,000 <br />PRODUCTS - COMP/OP AGO $2000000 <br />$ <br />B <br />AUTOMOBILE <br />_ <br />✓ <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEOULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />CFICA00155191 <br />3/23/2019 <br />3/23/2020 <br />COMBINED <br />DfINGLEUMIT $1000000 <br />BODILY INJURY (Per parson) $ <br />BODILY INJURY (Pon eculd.up $ <br />PROPERTY DAMAGE $ <br />Per eocldent <br />A <br />�/ <br />UMBRELLA LIAR <br />EXCESS LIAR <br />OCCUR <br />CLAIMB-MADE <br />XC1 EX00208191 <br />3/23/2019 <br />3/23/2020 <br />EACH OCCURRENCE $5000000 <br />AGGREGATE $5,000000 <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS' LIABILITY YIN <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />OFFICEMe REXCLUDEDP <br />(MentlaWry m NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE- POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Certificate Holder is named as Additional Insured as respects to General Liability per endorsement attached where required by written contract. <br />30 days notice of cancellation, 10 days for non-payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />Cit of Santa Ana <br />Y <br />Finance & Management Services Agency <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 />20 Civic Center Plaza P.O. Box 1988 M-16 <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE / II,, <br />av,f <br />Dave Jacobson U <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />97705760 119/20 GL/AU/OMB I Annette Romero 13/25/2019 3:13:59 PM (PDT) I Page 1 of 4 <br />This certifinar, canoels and eupexeedes ALL pxeviouely ieeued cnctificatee. <br />