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+� ; CERTIFICATE
<br />,. LIABILITY INSURANCE
<br />DATE, (MM1 13NY"
<br />11101512015
<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 INSURERIS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION I5 WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endomement(s),
<br />PRODUCER I c°nTTERKA STE'WWART
<br />TERRY IBRADSHAWW, AGENT
<br />State'Far l 17071 SANTIAGO BLVD., SUITE 207
<br />VILLA PARK, CA 92661'
<br />INSURED
<br />HENNESSEY & HENNESSEY, LLC,
<br />176012 17TH STREET, SUITE 117.2-246
<br />TU TIN, CA 9278,01
<br />U,714 537-4120 _ _ (AIC 714 637-426ti
<br />_ a rArc NSI. _ .w.
<br />ERIKA.. STEWART.T26D�"w, STATEFARM,.COM
<br />A ;State Farm General Insurance Company 25151
<br />B :,,State Farm Mutual Auto robIle Insurance Company 25178
<br />,.Stale Farre General Insurance Company _ 25151
<br />[*T+1s1 1111915671% 11121A II « •
<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 INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT' TO ALL THE rERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />ILT�R ..... ALIS � � n ._ ..__ .........., POLICYEFF pCYLiCY i7fP 1 LIMITS
<br />TYPE OF INSURANCE POLICY NUMBER MMPDD Ml 'DrY 'rY
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />+�
<br />EACg1CSCCURRENCE $ 1,000,000
<br />CLAIMS MADE OCCURPREMISES
<br />GCS 14T'FNIe rr 300,000 '
<br />S
<br />fi EMI E Ea OCsxurerar.M)_ .,._ ,.S
<br />I
<br />92 -CZ -W382.6
<br />OS11612016 0511612016
<br />MED I XP (Any odes Perscn) 5 5,0 00
<br />PCRSONAL S ADV INJURY 5 000°0,•__....
<br />dd
<br />GENII.
<br />AGGREGATE LIMITAPPUL5 PER:.
<br />GENERAL. AGGREGATE s 2,0041,000
<br />POLICY [7 PRO-, � I.,OC
<br />JECT
<br />PRODl1D TS D47MPrGP A4a a 2 000 '000
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<br />I
<br />OTHER'
<br />S
<br />B AUTOMOBILE LIABILITYCOMBlNED
<br />��ISINGLELIMIT
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<br />ANY AUTO
<br />471 7092-E19.75A
<br />� 1111912015 05119120 1 6
<br />BODILY INJUrtYiPcrrcrsonl_....$ALL
<br />AL TOS IEC7 SCHEAUTGiNJLED
<br />BODILY INJURY IPvf Kdr ertlj
<br />8
<br />...
<br />NON -OV NECI
<br />PRDFFRTY DAr4AUE
<br />MIRECYAIJT41.a " AUT115
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<br />_ _ _
<br />UMARELLA,LIAR X OCCUR
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<br />N
<br />92-CZ•W386-5
<br />0511612015 05116.12016
<br />EACFgOCCIJRREMdE.
<br />5 2,000,000.
<br />LIAR dL,AINIS-MADE
<br />�. C5 I,. ..
<br />AGGREGATE
<br />.._ _.. ... .
<br />S 2.000,000
<br />DED RETENTION $
<br />...
<br />S
<br />WORKERS COMPENSATION
<br />*"'f T� E OCRIH
<br />AND EMPLOYERS' LIABILITY YINANY
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<br />CI BERIIPAR
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<br />(Mandatory
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<br />0 SCAtPTION OF OPERATIONS L ,Pow
<br />F I. DISEASE - POLICY LIMIT
<br />� $
<br />'... DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additlonal Remarim Schedule, may he at1acheIr more space Isrequired)
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<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 />r*r+rs7 4*W*&FT11Cf'ffflI
<br />SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Terry Bradshaw, Ager11. Uc. Rd880821 Stat;EFa M
<br />AUTHORIZED REPRESENTATIVE
<br />1 M11 Se,It PW BW, SOW 2:07
<br />W h Pant,. CA 62061411,7 w, 1.
<br />I3,rs 76,0-G'374120 Talo rree8'SS821-5p55
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<br />1988-2014 A+..vr:Nw. v�#Ar•vn-,-v,a. no. s,9-. . ...rved.
<br />The ACORD name and logo are registered marks of ACORD 1001486 132849 9 02-04-2014
<br />
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