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CERTIFICATE OF LIABILI <br />Crosby Insurance, Inc <br />8181 E. Kaiser Blvd <br />Anaheim CA 92808 <br />Phone:714-221-5200 Fax:714-221-5210 <br />INSURED <br />i <br />Hennesse & Hennessey LLC <br />17300 17 h Street, J-�51 <br />Tustin CA 92780 %� ID_" /pA/ <br />COVERAGES /T <br />TY I N S U RAN C EOP ID DB DATE (MM/DD/YYYY) <br />HENNE-J 07/23/09 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOP <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 I NAIC # <br />INSURER A: Golden Eagle Ins Corporation <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />THE POLICIES OF INSURANCE LISTED 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 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 />LTR INSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MMIDD/YYYY <br />POLICY EXPIRATION <br />DATE (MMIDDfYYYYI <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE [X] OCCUR <br />CBP959582706/06/09 <br />06/06/10 <br />EACH OCCURRENCE $1,000,000 <br />PREMISES (Ea occurence) $ 100,000 <br />MED EXP (Any one person) $5,000 <br />PERSONAL & ADV INJURY $ Excluded <br />GENERAL AGGREGATE s2,000,000 <br />GEN, AGGREGATE LIMIT APPLIES PER. <br />POLICY PRO- <br />JECT LOC <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) $1,000,000 <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />A <br />X <br />X <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />CBP9595827 <br />06/06/09 <br />06/06/10 <br />BODILY INJURY <br />(Per accident) $ <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE <br />LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />EXCESS / UMBRELLA LIABILITY <br />A X OCCUR ❑ CLAIMS MADE <br />CU 8374163 <br />06/06/09 <br />06/06/10 <br />EACH OCCURRENCE $1,000,000 <br />AGGREGATE $ 1,000,000 <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />1 <br />APPROVED AS <br />r. (. <br />FORM <br />O 1 ORM <br />ORY LIMITS TER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE$ <br />11 <br />E.L. DISEASE -POLICY LLIMIT$ <br />Laura Stitt Sh <br />edy <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIKAfitB ECIAL PROVISIONS <br />SEE ATTACHED <br />CERTIFICATE Hol nFP <br />r rvry <br />,.?SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />V ', r' .. 1 1 j::ITYSAN DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />City Of Santa Ana IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Public Work IMPOSE LZ III U (J <br />P.O. BOX 198 4 REPRESENTATIVES. <br />Santa Ana CA 92702 AUTHORIZED REP ENT E <br />ACORD 25 (2009/01) ZeL9 ACORD CORPORATION. All rights reserved. <br />r rra m%,%art„ Marne ana logo are reglstereci marks of ACORD <br />