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A-CQBLD, CERTIFICATt OF LIABILITY INSURAN.,E <br />DATE <br />1 03/09/2 0 (MMIDOiYYYY) <br />PRODUCER (714)905-1923 FAX (714)905-1910 <br />Hayward Tilton & Rolapp Ins. Assoc., Inc. <br />License #0614365 <br />P.O. Box 25S29 <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-;W01-1-')-ff <br />^ <br />7 7 <br />A - �0 3 1i <br />INSURERA: Nautilus Insurance Company <br />INSURER B: <br />INSURER C: <br />NSURER O: <br />NSURER E: <br />rnveoAcee <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 CONTRACT OR 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 />:NSftADD' <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />PCUCYEFFECTIVE <br />POLICYEXFIRATION <br />LIMITS <br />GENERAL LIABILITY <br />NC311366 <br />03/04/2004 <br />03/04/2005 <br />EACHOCCURRENCE <br />E 1,000,000 <br />X COMMERCIALGENERAL LIABILITY <br />DAMAGE TO RENTED <br />E 50,000 <br />CLAIMS MADE a ODOUR <br />MED EXP (Any one person) <br />S 1,000 <br />A <br />X <br />PERSONAL &ADV INJURY <br />E 1,000,000 <br />GENERAL AGGREGATE <br />$ 1,000,000 <br />GENt AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMNOP AGG <br />E Included <br />POLICY PRO <br />JECT r LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />ANY AUTO <br />(Ea accident) <br />ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY <br />E <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Par accident) <br />PROPERTY DAMAGE <br />S <br />(Par accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />S <br />EA ADC <br />ItOAN <br />ANY AUTO <br />E <br />AUUTOTO OONLNLY: AGG <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />E <br />OCCUR ❑ CLAIMS MADE <br />E <br />S <br />DEDUCTIBLE <br />RETENTION E <br />/ YY <br />C I� <br />i <br />ItWORKERS <br />COMPENSATION AND <br />V STATU OTq <br />Tnpv ,!.,g(TS�_ <br />-- - <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNEWEXEOUTIVE <br />E.L. EACH ACCIDENT <br />E <br />E.L. DISEASEEA EMPLOYE <br />E <br />OFFICEWMEMBER EXCLUDED? <br />I/yes, descrice under <br />E.L. DISEASE-POLICYLIMIT <br />S <br />SPECIAL PROVISIONS GeIow <br />OTHER <br />DESCRIPTION OF OPERATIONS LOCATION VEHICLES/EXCLUSION ADDED BY ENDORSEMENT/ S ECIAL PRQVISIONS <br />elation <br />Ten days notice of cance given Tor 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 MSS <br />220 S. Daisy Avenue, Bldg A <br />Santa Ana, CA 92703 <br />ArnPn,R/PnnunAi FAX- r7141647-3345 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL K`X1XXlyE3GXr21 MAIL <br />__30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br />P(rYi(=Xt(d�]�XiXXa6X)fYdGXiYdEtEXXxaY]OGAli�476XX;1(LXXi(�1UFXXX' <br />AUTHORIZED REPRESENTATIVE <br />A �tII IFlorly4ma <br />1A1_on nneOnOwrinl.l FOR% <br />Printed with FinePrint 2000 - purchase at http://www.fineprint. <br />