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GRAFPRO.01 r CSHARI
<br />CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY)
<br />2119/2020
<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(ies) 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 p 0757776 22UTACT
<br />INSURED
<br />-HUB International Insurance Services Inc.
<br />Rd.
<br />94520
<br />Graffiti Protective Coatings, Inc.
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />PHONE FAX
<br />,Arc.. ��No.
<br />E.O: (925) 609-6500 INC. No):(925) 609-6550
<br />ADDpRESS.
<br />INSURER(S) AFFORDING COVERAGE NAIL i
<br />INSURER A: Colony Insurance Company 39993
<br />INSURER B: Liberty Mutual Fire Insurance Company 23035
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<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 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 Lm TYPE OF INSURANCE ADOL SUER pOMCY NUMBER Impamm,
<br />POLICY EXP LIMITS
<br />A X COMMERCIALGENERALUAe1LRY 1,000.000
<br />EACH OCCURRENCE S
<br />CLAIMS -MADE X OCCUR X PACEP4245050-01 2/17/2O20 211712021 PREMISESDAIJAGETO RENTED
<br />once) S 100,000
<br />X BI/PD Dad: 2,500 MED EXP (Any one person) S 5,000
<br />PERSONAL A ADV INJURY S 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 5 2,000,000
<br />POLICY X JECT LOG PRODUCTS - COMPrOP AGG S 2,000,000
<br />_ OTHER GOMOINED SINGLE LIMIT 5 1,000,000
<br />8 AUTOMOBILE LIABILITY (Ea emdent 5
<br />X ANY AUTO X X AS2-Z91-466837-010 111/2020 111/2021 BODILY INJURY(Parpersoni S
<br />AOIWNED JqqE 3ONLY AUTOSCppSCHEDULED BODILY INJURY (Per accident) S
<br />AUT030NLY N8TO50NL� (pOTa¢Cem. AMAGE 3
<br />5
<br />UMBRELLALIAB OCCUR EACH OCCURRENCE S
<br />EXCESS LIAR CLMMB-MADE AGGREGATE S
<br />DED RETENTIONS S
<br />B WORKERS COMPENSATION X PER
<br />ERH
<br />AND EMPLovI:Rs•LIABRm WC2-Z91466837.020 1/1/2020 11112021 1,000,000
<br />OFFILER,MEMTgg RIEPARTUOEDaXECUTIVE YIN NIA X EL EACH ACCIDENT S
<br />(Mandatary in NH) EL DISEASE-EAEMPLDYEE S 1,000,000
<br />II yes. devnba under 1,000,000
<br />DESCRIPTION OF OPERATIONS baloi, ._ EL DISEASE - POLICY LIMIT 5
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Addlllanal R...r . Schedule, may be allached N mom apace is reyalredl
<br />Re: Service Contract
<br />City of Santa Ana, Its officers, agents, employees and representatives, as additional Insured as respects to General Liability per attached forms
<br />EPACE101-0814 & EPACE100-0814, and coverage applies on a Primary & Non -Contributory basis per EPACE107.0714; and additional insured in respects to
<br />Auto Liability per AC8467 0415. Waiver of Subrogation applies to Auto Liability per AC8407 0713, pg. 10 of 11, XXIII, and Workers Compensation per
<br />WC040306 (4-84). As required by written contract.
<br />�30-D8y Notice of Cancellation for General Liability will be provided In accordance With attached form EPACE706.0114.
<br />r,CVWW[rR APPROVED
<br />CERTIFICATE HOLDER a—
<br />DIVISIOIVCANCELLATION
<br />V7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />C' of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Flo
<br />Santa Ana, CA 92702 AUTHORIZEO R�EPRE`SENTATIVE
<br />tL_
<br />ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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