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<br />AmRa, CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY) <br />03/28/2005 <br />.Rooue.. (714)905 1923 FAX (714)905-1910 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Hayward Tilton & Rolapp Ins. Assoc., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />License #0614365 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />P.O. Box 25529 <br />Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED Hernandez Cart Servi ce I Inc. INSURER A: Nautilus Insurance Company <br />1808 Lincoln Blvd. INSURER B: State Compensation Ins Fund <br />Venice, CA 90291 ~ <br /> INSURER C <br /> ~ <br /> INSURER 0 <br /> ~ <br /> INSURER E <br /> <br />COVERAGES <br />THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V\IITH RESPECT TO VVHICH THIS CERTIFICATE MAY BE ISsueD OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOAlL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POliCIES. AGGREGATE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR 00' TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE PR~!$=,r EXPIRATION LIMITS <br /> GENERAL UABILITY NC400101 03/04/2005 03/04/2006 EACH OCCURRENCE I 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENte~ I 50.....QQI: <br /> ~ ~ CLAIMS MADE [!] OCCUR ~D EXP (Anyone person) I 1,000 <br />A X PERSONA~&ADV\NJURY I 1,000,000 <br /> - <br /> GENERAl AGGREGATE I 1,000,000 <br /> ~~AGG~nE LIMIT APf~'Y PER: PRODUCTS. COMP/OP AGG I Incl uded <br /> POLICY j~8T lOC <br /> ~TOMOB\\...E UA8IUTV VO'r-'N COMBINED SINGLE LIMIT I <br /> ANY AUTO (Esllccidllnl) <br /> - <br /> ALl OWNED AUTOS \0 BODILY INJURY <br /> -- .~ I <br /> SCHEDULED AUTOS ". (Per person) <br /> - ll'i '<"\) 14/~ ~~- - <br /> HIRED AUTOS BODILY INJURY <br /> - t>,,\,'i'~ I .-/ .' I <br /> NON.OIfolNED AUTOS .</. '!d (PeraCCldefll) <br /> - JL'J I .'r ':-J\Y':-v e") <br /> - -. . /'A'----"..--:' PROPERTY DAMAGE <br /> \\. to{\\ (Persccident) I <br /> ~ ~~ .'. " 1\.' <br /> ~~GE'IABILlTY v. _\,.\-(\'i AUTO ONLY - EA ACCIDENT I <br /> ANY AUTO r>.c:.-::'\~ EA ACC I <br /> or HER THAN <br /> AUTO ONI.. y AGG I <br /> ==r:SSlUMBRE\.\.A UA.B1L1TY EACH OCCURRENCE I <br /> OCCUR 0 CLAIMS MADE AGGREGATE I <br /> I <br /> =1 ~EDUCTIB" I <br /> RETENTION I I <br /> WORKERS COMPENSATION AND 1818185 2005 02/12/2005 02/12/2006 X r~ ST ~.T~-" TO,!.'!- <br /> EMP\...OYER.S'UABlI..1TI l,OO~ <br />B ANY PROPRIETOR/PARTNER/EXECUTIVE t;.L EACH ACCIDENT I <br /> OFFICER/MEMBER EXClUDED? E.~, DISEASE - EA EMPLQ'l'E I 1 000,000 <br /> It yes, OesCrlOliundElf 1 000 000 <br /> SPECIAL PROVISIONS belO'N E L. OISEASE - POLICY LIMIT I <br /> OTHER <br />'p~SC~]10N Of rERAnoNS fLOCAT!9N31VEr,I.ESl EXCLUSIONS-(;DDED BY ENDORSEMENT { SPECI1L PROVISIONS <br />he lty 0 Santa Ana ,ts 0 leers, emp oyees, agents, vo unteers & representatives are <br />additional insureds as respects General Liability per endt S114 (04.97) <br />:ertificate revises and super cedes cert issued 03/21/05. <br />'Except 10 Day Notice of Cancellation for Non-payment of premium applies. <br /> <br />CERT FI ATE <br /> <br />LDE <br /> <br />CA <br /> <br />LA <br /> <br />The City of Santa Ana <br />Attn: Dave Urbin <br />220 S. Daisy Avenue, Bldg A <br />Santa Ana, CA 92703 <br /> <br />SHOULD ANY OF THE ADOVE DESCRISED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUiNG INllURER WII..L Jl'IXitX~>> MAIL <br />'* 30 PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />lOOl;XII:_ IC:llXI(Jl(XJl>>Ii~~XX: <br />. XXXXXXXX: <br /> <br />ACOR025(2001J08) FAX: (714)647-3345 <br /> <br /> <br />Hi <br /> <br />@ACOROCORPORATION 1988 <br />