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Ac mbp CERTIFICATE OF LIABILITY INSURANCE <br />°071022014 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE. ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADOMONAL INSURED, the pollcy(los) most be endorsed. R SUBROGATION IS WAIVED, subject to <br />the terms and COhdltI0 S Of the pdeCy, Certain policies may require an andomement. A.statement on this certificate does not confer rights to the <br />Certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />TERRY BRADSHAW, AGENT <br />StateFarm 17871 SANTIAGO BLVD., SUITE 207 <br />VILLA PARK, CA 92861 <br />NA CONTACT ERIKA STEWART <br />E: <br />PHONE 713.637 11 z0 FA 713 s9742sC <br />A!9.tl,L.._.-._.-.-.______ <br />a oaLss; ERIKA.STEWART.T2e0@STATEFARM.COM_ <br />_.. _ <br />INSURERISI AFFORDING COVERAGE T T NAIL# <br />IN ORERA:State Farm Fire and Casualty Company 25143 <br />INSURED <br />HENNESSEY& HENNESSEY, LLC. <br />17602 17TH STREET, SUITE 102-248 <br />TUSTIN, CA 92780 <br />INSURER e <br />INSURERC: <br />INSURER U; <br />INSURER E: <br />INSURER Fo <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR. THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR LTA <br />TYPE OF INSURANCESUOR <br />PUBLIC WORKS <br />POLICY NUMBER <br />MMIUDY EF <br />MMJUQP <br />UNITS <br />A <br />x <br />COMMERCIAL GENERAL UASUTY <br />CWMS+MAOE OCCUR <br />Y <br />I <br />92 -CZ -W382-6 <br />05!1612014 <br />OSM612015 <br />EACH OCCURRENCE S 1.000,000 <br />DAMAGETO RENTED <br />I+REMIS ES E8—Nanu S-300 DOB <br />MEDEXP any mepereun) $ 5,000 <br />PERSONLADVINJURYS L000,000 <br />GRN'L AGGREGATE LIMIT APPLIES PER: <br />x POLICY ❑ jG7 EILOC <br />GENERAL5 2,000,000 <br />PRODUC4 2,000,000 <br />EAUrOMOWLEUAWLITY <br />ANY AUTO <br />ALL Ot°MEO SCHEDULED <br />NOWOWNED AUTOS <br />H REDSAUTOS X UTO <br />N <br />4717092-E19d6 <br />05/19/2014 <br />11/19t20'14 <br />Ea Cidpa 1,000,000 <br />!ODILYINJURY(Per Paman) E <br />BODILY INJURP(PBrexatlpn(j $ <br />wo <br />� Mbm $ <br />4 <br />C <br />x <br />UMBRE UA9 <br />EXCESS LIAR <br />X <br />OCCUR <br />CtAIMS•M4DE <br />N <br />92.Cz-W38" <br />05/1612014 <br />0511612015 <br />EACH OCCURRENCE t 2,000,000 <br />AGGREGATE $ 2,000.000 <br />OED I <br />f RETENTIONS <br />S <br />WORKERS COMPENSATION <br />ANDEMPLOYSMETUABIUTY YIN <br />ANY PROPMETORIPARTNEREXECUTNE© <br />OFFICERIMEMBER aXCLUDEDP <br />(MandalUry in NN) <br />0vas.descrl Nnndar <br />EflCRIPTION bF OPERATIONS belmv <br />MIA <br />W bR - <br />E.L. EACH ACCIDENT S <br />EL0ISEA9E-EA EMPLOYE 5 <br />--'-- <br />E.L. DISEASE -POLICY LIMIT 4 <br />E <br />i <br />DESCRIPTION OF OPERATIONS/ LOCATIONSIVEHICLES JAC ERD 131, A441fl4 W l Name" Schedule, may ba 014094 If Moro ;Paco Is mVUlred) <br />PPROVED AS TO FORM <br />Laura A. Rossini <br />-'w:nior Assistant City Attorney <br />CERTIFICATE HOLDER CANCELLATION <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />MARILYN BOOTHE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PUBLIC WORKS <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />20 CIVIC CENTER PLAZA (M•36) <br />AurxoluzeaREPRESENranvS TQ BtGdSllilvv/ t�jent1 <br />SANTA ANA, CA 82702 <br />C 1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1001486 132949,9 02.04.2014 <br />