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HEf�EY & HENNESSEY, LLC A-2006-046 REVIEWED 16`x`
<br />EUNICE HERECIIA (PG '1 OF a)'
<br />r
<br />rx,t CERTIFICATE' OF LIABILITY INSURANCE
<br />LATE (MMIDDIYYYY)
<br />G7/06/2015
<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 INSUIRER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SU13ROGATION IIS WAIVED, subject to
<br />the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endoirsement(s).
<br />PRODUCER
<br />TERRY BIRADSHAW, AGENT
<br />StateFarm 17871 SANTIAGO BLVD,, SUITE 207
<br />,�+�
<br />VILLA PANIC, CA 92861
<br />s � ,.
<br />CONTACT ERIKA STEWART
<br />NAME;
<br />PHONE 714_'637-4120 FAX 63? -4260
<br />(?!Je TextJ: I91c N„,714-],_ ....
<br />E-MAIL ERIKA,STEWART.T280@STATEFARM.COWf
<br />1)DRE ,S,
<br />INSURER(S) AFFORDING COVERAGE
<br />NAtC is
<br />INSURER A :Mate Farm General Insurance Company
<br />15151
<br />INSURED
<br />Slate Farm Mutual Automobile Insurance Company
<br />INSURER 13 c R
<br />................25178
<br />HENNESSEY & HENNESSEY, LLC.
<br />INSURER C:
<br />117642 17TH STREET, SUITE 102-246
<br />INSURER 0:
<br />GENERAL AGIGRFGATE $ 2,000'ow
<br />TUSTIN, CA 92784
<br />INSURER E
<br />B
<br />INSURER F
<br />LIABILITY
<br />ANY AUTO
<br />ALLOVVNEO SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />N
<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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WNTH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HFRIFIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />'.IPOLICY
<br />LTR
<br />TYPE OF INSURANCE
<br />”
<br />U
<br />FOUCY NUMBER
<br />MMLDD CY EFF
<br />EXP
<br />MM DDfYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL. GENERAL LIABILITY
<br />.I. CLAIMS -MADE r..., ^ * I..
<br />lI
<br />1e
<br />d�' OCCUR
<br />Y
<br />92-CZ-dW3$2-6
<br />0511612015
<br />05116120161
<br />EACH OCCURRENCE... $ 1,000,000
<br />iSf1A GF'T0 RT"NTF
<br />PREMISES Ea rscoaln-inc S 960,000
<br />MED EXP (Anyone person) S 5,000
<br />PERSONAL 8 ADV INJURY' $ 1,000,000
<br />GENrL AGGREGATE LIMIT APPLES PER:
<br />Pot, ICY ❑ PRCLOC
<br />JFCT
<br />OTHER:
<br />GENERAL AGIGRFGATE $ 2,000'ow
<br />PRODUCTS -COMPlOPAGG $ 2,000,000
<br />..,,.„,.....$
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALLOVVNEO SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />N
<br />471 7092-E19-75
<br />0511912015
<br />/1119/2015
<br />COMBINED SINGLE LIMIT $ 1D00,000
<br />(Fe Rcciclonil
<br />BODILY' INJURY (Per person} $
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accadent
<br />$
<br />C
<br />X
<br />UMBRELLA UAB
<br />EXCESS LIAR
<br />;,'Y,
<br />OCCUR
<br />CLAIMS -MADE
<br />N,
<br />92 -CZ -W3$6-5
<br />051191201,5
<br />0511612016
<br />EACH OCCURRENCE $ 2,000,000
<br />AGGREGATE $ 2',000,900..
<br />$
<br />DED,'. RETENTIONS
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY Y F N,,.
<br />ANY PROPRIETORIPARTNERIEXECUTIV-=
<br />OFFICE—EMBER EXCLUDED?'
<br />IMantlatury #ni. NH)
<br />If yes, describe lander
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />BTATUTE. ER.
<br />E.L.IEACH ACCIDENT $
<br />E . DISEASE - FA EMP4-OYFF s
<br />E.L. DISEASE -POLICY LIMIT 5.
<br />DESCRIPTION OF OPERATIONS I LOCATIONS!' VEHICLES: ("CORD... 101, Adtlltroml Remarks SeheduVe, may he a"ached Ir imare space Is required}
<br />CERTIFICATE, HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />MARILYN BOOTHE,
<br />PUBLIC WORKS
<br />20 CIVIC CENTER PLAZA {M-36}
<br />SANTA ANA, CA 92702
<br />ACORD 25 (20114101)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />@1
<br />rrl:.�Ir�Irn�I
<br />The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014
<br />
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