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C40RCERTIFICATE OF LIABILITY INSURANCE OP ID DB DATE(MM/DD/YYYY) <br />HENNE-J 07/16/10 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <br />Crosby Insurance, Inc <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />8181 E. Kaiser Blvd <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />Anaheim CA 92808 <br />LIMITS <br />Phone: 714-221-5200 Fax: 714-221-5210 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />` <br />INSURER A: Golden Eagle Ins Corporation <br />INSURER B: <br />INSURER <br />Hennesse & L,C V <br />17300 17th Street, JHennessey=251 <br />Tustin CA 92780 <br />INSURER D. <br />INSURER E. <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE 7 OCCUR <br />COVERAGES <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 <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECT] <br />DATE MMIDDIYYYY <br />PIRATION <br />DATE MM/DDIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE 7 OCCUR <br />CBP9595827 <br />06/06/10 <br />06/06/11 <br />PREMISES(Ea occurence) $ 100,000 <br />MED EXP (Any one person) $5,000 <br />PERSONAL 8 ADV INJURY S Excluded <br />GENERAL AGGREGATE s2,000,000 <br />GE 'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG s2,000,000 <br />POLICY PROJECT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT $1000,000 <br />(Ea accident) i <br />A <br />X <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />CBP9qPP-OvE) <br />S OT,06 <br />6/06/11 <br />OeINJURY <br />(Per BODILY $ <br />BODILY INJURY $ <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />ANY AUTO <br />ASSIS[(IIIC C;1C <br />311ucuy <br />AUTO ONLY - EA ACCIDENT $ <br />EA ACC $ <br />OTHER THAN <br />AUTO ONLY: AGG $ <br />EXCESS I UMBRELLA LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />X OCCUR F -I CLAIMSMADE <br />CU 8374163 <br />06/06/10 <br />06/06/11 <br />AGGREGATE $ 1,000,000 <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />- <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNERIEXECUTIVEE:l <br />OFFICER/MEMBER EXCLUDED? <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory In NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT $ <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />SEE ATTACHEDZEE <br />►J <br />V <br />CERTIFICATE HOLDER CANCELLATION "' •1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE9A CELLED �RE THE EXPIRATION <br />CITYSAN DATE THEREOF, THE ISSUING INSURER WILL ENDEAV RPtIL DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE CEF1 T FAIL* 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 Works Agency REPRESENTATIVES. <br />P.O. Box 1988 <br />Santa Ana CA 92702 AUTHORIZEDREIVE <br />I <br />The ACORD name and logo are registered marks of ACORD <br />