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AP C-ORCERTIFICATt OF LIABILITY INSURAN%,E <br />DATE <br />03/09/2004' <br />PRODUCER (714)905-1923 FAX (714)905-1910 <br />Hayward Tilton & Rolapp Ins. Assoc., Inc. <br />License #0614365 <br />P.O. Box 25529 <br />Anaheim, CA 92825-5529 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED Hernandez Cart Service, <br />DBA: <br />1808 Lincoln Blvd. <br />Venice, CA 90291 <br />Inc. A <br />A VV ,C <br />A _ i47 <br />INSURER A: Nautilus Insurance Company <br />INSURER B: <br />INSURER C: <br />INSURER O: <br />"UPERE: <br />rnvooerce <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />:NSR DD' <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />PCL:CY EFFECTIVE <br />DATE WOOED= <br />POLICYEXFIRATIONIT, <br />DATE (MMIC12.200— <br />LIMITS <br />GENERAL LIABILITY <br />NC311366 <br />03/04/2004 <br />03/04/2005 <br />EACH OCCURRENCE <br />$ 11000 000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PROFMIRPS OF, <br />$ 50,000 <br />CLAIMS MADE a OCCUR <br />LIED EXP (Any one person) <br />$ 1,000 <br />A <br />X <br />PERSONAL A ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 1,000 00Q <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG <br />$ Included <br />POLICY PRO- <br />ECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />ANY AUTO <br />E. accitlent) <br />BODILY INJURY <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY <br />$ <br />HIRED AUTOS <br />NON.OWNEO AUTOS <br />(Per accitlent) <br />PROPERTY DAMAGE <br />$ <br />(Per acaaenq <br />GARAGE LIABILITY <br />AUTO ONLY- EA ACCIDENT <br />S <br />OTHER THAN EA ACC <br />$ <br />ANY AUTO <br />S <br />AUTO ONLY: AGO <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />S <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />f <br />$ <br />f <br />DEDUCTIBLE <br />RETENTION $ <br />/ <br />L <br />. i A <br />$ <br />WORKERS COMPENSATION AND <br />If <br />we STgTU- OToH <br />T2V y$ITg` <br />EMPLOYERS' LIABILITY <br />ELEACH ACCIDENT <br />S <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />E.L. DISEASE - EA EMPLOYEE <br />f <br />OFFICERIMEMBER EXCLUDED9 <br />9 Yes, <br />SPECIAL PROVISIONS oelo,t <br />SPECALPRe ISD <br />E.L. DISEASE -POLICY LIMIT <br />f <br />OTHER <br />DESCRIPTIONOFOPEPATIONS LOCATION VEHISLESIEXCLUSION ADDED BY ENDORSEMENT IS ECIAL PROVISIONS <br />Wor <br />en days notice of canceil5ation given non-payment or premium. <br />The City of Santa Ana its officers, employees, agents, volunteers & representatives are <br />additional insureds as respects General Liability per endt S114 (04.97) <br />The City of Santa Ana <br />Attn: Dave Urbin MSC <br />220 S. Daisy Avenue, Bldg A <br />Santa Ana, CA 92703 <br />ArnRn DsrDnnunA) FAX: (714) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL WX08XXX MAIL <br />DAYS WRITTEN NOTIC E TO T H E C ERTI FICATE NO LD ER NAM E D TO THE LEFT <br />AUTHORIZED REPRESENTATIVE <br />Stenke-n Morivamck <br />nAlrnon rnGDnDATInM 1CRI <br />Printed with FinePrint 2000 - purchase at http://www.fine <br />