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<br />Ma~ 03 07 11:08a
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<br />Public Works
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<br />7146473345
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<br />p.3
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<br />ACORD", CERTIFICA TE OF LIABILITY IN::HJRANCE DATE (Mi:DDfYYYY)
<br /> 4/27 2007
<br /> ....-.-. .-,--.. MATTER OF INFORMATION
<br />PRODUCER (714) 905-1923 FAX; (714) 905-1910 THI::;CI::RJ'lFICATE IS ISSUED AS A
<br />Hayward Tilton & Rolapp Associates, ':lNI:, "Nt> CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />Insurance 1-10 1.I1=~, 'If HIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />License #0614365 ,_,:~L "!I :U !:g: COVERAGE AFFORDED BY THE POLICIES BELOW,
<br />888 S, Disneyland Dr. STE 400
<br />Anaheim CA 92802 I,~SUI~ I~!? ~!::FORDlNG COVERAGE' NAIC#
<br />-~
<br />INSURED 1nc./ 11l':URI'F '.. I~:al:ltilus Insurance
<br />Hernandez Cart Service, II!, URE!" " H al::tford Ins, , The
<br /> ~ -
<br />1808 Lincoln Blvd, A -~ooJ./- /3 J( IIl'URFf ;~! ce:~ Property & Casualty
<br /> IIL,URl'f ._~. --.
<br />Venice CA 90291 III'URI,R
<br /> ..,,-.-. '-'- ""-~.
<br />THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE[i':~A~~E ';-: ~ iCivE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY
<br />RFQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT \I'"'-H "I 'iF [: C r TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC r TO ' Ll filE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
<br />AGGREr.ATF liMITS ~H()WN MAY HAVE BFF ~ RFI1UCED BY PAlO ~I AIMS .-..-.- - --"
<br />INSR ADO'L TYPE OF INSURANCE PO J';Y E:F "cr VI' POLICYtFXPIRATlgN LIMITS
<br /> POLICY NUMBER D':IU!:l.~: !Em. DATE MMIDDIYY
<br /> GENERAL LIABILITY V I ~A\;li OC<:llRRENCE $ 1,000,000
<br /> - DAMAGE TO RENTED
<br /> X 3MMERCIAL GENERAL LIABILITY 13/4/2008 $ 50,000
<br /> ~ CLAIMS MADE 0 OCCUR PREMISES {E~ 9~~rrencel
<br />A NC64230B 3.' 'I/~! ( ,I' MED EXP IArv one oersorl $ 1,000
<br /> ~ --
<br /> P~RS()NAL & ADV INJURY $ 1,000,000
<br /> GtNERALAGGREGATE $ 1,000,000
<br /> ,--
<br /> GEN'L AGGREGATE LIMIT APPLIES PER' : oRODUCTS - COMP/or AGG $ Included
<br /> Xl POLICY n P'fR,: h LOC .-".-.- .-,..-.
<br /> ~TOMOBlLE LIABILITY . V COMBINED SINGLlc liMn $ 1,000,000
<br /> ~ ANY AUTO iE. acc,dent)
<br />B ALL OWNED AUTOS 72UENTQ5077 5::!/~~C :,~ 5/2/2008 BODIL Y INJURI(
<br /> f---~ \ Per person} $
<br /> c- SCHEDULED AUTOS --"-....'-
<br /> ---i HIRED AUTOS , I I ROIIIII( INJURY
<br /> , (Per acc,d~l"It) $
<br /> I NON-DWNEDAUTOS
<br /> ~- tI--';:> /) LJ<ly - -
<br /> \
<br /> /' :>.f""A 1 PROPERTY IIAMAGF $
<br /> -:.~,,___I (Per .cc,denl)
<br /> GARAGE LIABILITY I ,r _AU I U UNL Y - tA ACClllcN I $
<br /> ~ ANY AUTO ..." ~ -
<br /> OTHER T-lAN E8 ACe $.
<br /> AlITO ONL I( AGG $
<br /> ,.....-.-..-'..
<br /> EXCESS/UMBREllA LIABILITY ~ACH ~" $
<br /> =:J OCCUR D CLAIMS MADE AGGREGA..IL_ ~
<br /> $
<br /> =i DEDUCTIBLE I -- $
<br /> RE'TENTION t ......-.-. .-,--. $
<br />C WORKERS COMPENSATION AND I Tv;:~nAJN:~ I jOJf
<br /> EMPLOYERS' LIABILITY 1,000,000
<br /> ANY PROPRIETORIPARTNERIEXECUTNE E L EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? C44701297 7; 1/20 I~ 7/1/2007 [L DISEASE - EA EMPLOYEE $ 1,000,000
<br /> If ye5. de6Cnbe under 1 000,000
<br /> SPECIAL PROVISIONS below .~"-'- '-''''-' E L DISEASE - POLICY LIMIT $
<br /> OTHER
<br /> ....M_'__ ,_,~._.'
<br />DESCRIPTION OF OPERA TIONSlLOCA TIONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISP I:C IAL 1>1' :)\ " lie NS
<br />THIS IS FOR THE AUTO lU:NEWAL ONLY_ PRIOR CERTS HAVE BEEN ISHIED (,I (T,IER LINES OF COVERAGE.
<br /> .""-'- .-,~,-..
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<br />CERTIFICATE HOLDER
<br />(714) 647-3345
<br />The City of Santa Ana
<br />Attn: Dave Urbin
<br />220 S, Daisy Avenue, Bldq A
<br />Santa Ana, CA 92703
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<br />q\~:€1 ,~~ mlN
<br />:il'IOUI,1.! A '/' DF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />I'XPIRiI1:1~ DHE THEREOF, THE ISSUiNG INSURER WILL Xr,l6~~ MAIL
<br />'r:30 I ~"i VII~rTTEN NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ~
<br />X)ii~~'I1l!~~:~~~~*~~~~
<br />X~~;~@ .~:~~~~~
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<br />AlflHOr::I;: ,0 I' EI'I~ESE:NTATlVE
<br />T\.' ,LY 'J, ","/MTA
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<br />~~~
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<br />ACORD 25 (2001/08)
<br />INS025 (0108),Olla
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<br />AfrY1l'f,ltf- 4 - ~'01-- M
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<br />~ACORD CORPORATION 1988
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