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<br />ACORD,.
<br />
<br />PRODUCER (626) 584-3040 FAX: (626) 795-4881
<br />Hayward Tilton & Rolapp Insurance Associates,
<br />License #0614365
<br />225 S. Lake Avenue,
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE ~/T~~M~g~)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />Suite 250
<br />CA 91101
<br />
<br />Pasadena
<br />INSURED
<br />TSJ Electrical & Communications
<br />DBA: Masters Electric
<br />11651 Sterling Avenue I Suite H
<br />Ri verside CA 92503
<br />
<br />AI ,,~O() 7./0r
<br />
<br />INSURERS AFFORDING COVERAGE
<br />INSU",,'(A Admiral Insurance
<br />~IIISURER B: Praetorian Insurance
<br />INSURER C
<br />INSURER 0
<br />INSURER E'
<br />
<br />Inc.
<br />
<br />NAIC#
<br />
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
<br />REQUIREM!:Nl. TERM OR CONDITION OF ANY CONTRACT OR OHlER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE; TERMS, EXCLUSIONS AND CONDITIONS OF
<br />Ar.GRFnATE LIMITS SHOWN MAY HAVE BEEN REDUC!::D BY PAID CLAIMS
<br />INSR ADD'lT 1- POLICY EFFECTIVE POLICY EXPIRATION
<br />TYPF OF INSURANCE -t-__~LICY NUMl!f~_ OATE{r,U.I'OD/vYl- DAT~!:,,[lDlY'!L __ LIMIT,S
<br />
<br />Ef4ENERAL L1AdILITY I EACH OCCURRENCE $
<br />
<br />X COMMERCIA" GENERA_ LIABILITY ~~~~!'m:~~.!.~P.nce $
<br />
<br />A CUlIMS M~OL [1U OCCURI CA000006B97-03 4/20/2007 4/20/2008 MEDEXP(Anvoneoersonl $
<br />
<br />,---j - I PERSrlNAL & ADV INJURY $
<br />
<br />--.J . I GENERAl AGGREGATE $
<br />
<br />3EN'L AGGR"EGiGATE I IMITA riPPL.ES PER', PROOUr.rS _ COMPIOP AGG $
<br />1 PRO-
<br />POLICY X JFCT LaC
<br />
<br />AUTOMOBILE LIABILITY
<br />
<br />R ANY Al, TO
<br />
<br />--' Acl OWNED AUTOS
<br />
<br />__ SCHEDULED AUTOS
<br />
<br />HIReD AUTOS
<br />
<br />NON.OIVNED AUTOS
<br />
<br />I----- - -.____
<br />
<br /> COMBINED SINGLE LIMIT $
<br />! (Ea aceIOMI)
<br /> BODILY INJURY $
<br /> (Per person)
<br /> BODilY INJURY $
<br /> (Per accident)
<br /> PROPERTY DAMAGE $
<br /> (Per acciden,)
<br />
<br />GARAGE L1ABIUTY
<br />H'ANV AUTO
<br />
<br />EXCESS/UMBRELLA LIABILITY
<br />:=J OCCUR D CLAIMS MADE
<br />
<br />RDEDUCTIBlE
<br />RHE/\ TIO'J 3
<br />
<br />/, ,',
<br />
<br />/'j J
<br />~ /Tn A /) .J 'J,",^ ., '/7/H
<br />d -- -.- ,........ ,.~ 'v """"""" __
<br />
<br />'n
<br />. I .1'. I, .'
<br />v
<br />
<br />
<br />~O ONLY - EA ACCIDENT $
<br />
<br />OTHER THAN FA ACi" $
<br />AUTO ONLY, AGG $
<br />
<br />J
<br />iFf
<br />
<br />EAi"H n"''''''RRF''''''F
<br />AGGREGATF
<br />
<br />$
<br />$
<br />$
<br />$
<br />$
<br />0;Fri.1
<br />
<br />I
<br />!
<br />
<br />I POOll000034576
<br />
<br />10/18/2006 10/18/2007
<br />
<br />E,L. DISEASE - EA EMPLOYEE $
<br />E.L. DISEASE - POLICY LIMIT $
<br />
<br />E
<br />
<br />WORKERS i"OMPF~S.A'T'!(),,! AWl
<br />EMPLOYERS' LIABILITY
<br />
<br />ANY PROPRIL TOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />
<br />N yes, deSCribe under
<br />SPECIAL PROVISIONS belo...
<br />
<br />OTHER
<br />
<br />!
<br />I
<br />
<br />;~ i l~RfTf~Ys L
<br />E.L~EACH ACCIDENT
<br />
<br />SUCH POLICIES.
<br />
<br />---~
<br />1,000,000
<br />50 ,_0~
<br />Excluded
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />
<br />-'-
<br />
<br />-~
<br />
<br />---
<br />
<br />$
<br />
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />
<br />DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
<br />RE; The Depo~ at Santa Ana - Certificate HO~der, its of~icers, employees, agents, representatives and volunteers are
<br />added as addit~onal insured as respects services provided by the named insured per form form AD 06 61 0104 for General
<br />Liabi1~ty only. Primary & Non-con~ributory per form AD 06 57 1203 Cancellation*10 days notice for
<br />non-payment of premi~.
<br />
<br />CERTIFICATE HOLDER
<br />(714) 565-2693
<br />The City of Santa Ana
<br />Attn: Laura Sheedy
<br />1000 E. Santa Ana Blvd.
<br />Suite 108
<br />Santa Ana, CA 92701
<br />
<br />CANCELLATION
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIlE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 1iit11l['''OlR. TO MAIL
<br />~3~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, WJ.
<br />
<br />rAllWR.t"Fe PO 8Q &I"'lb.lr,p~tr'l ttQ gg~;"TJOtl Q~ b.la-u.rrv Qf A~ KIrts llIPQtJ TfJ'
<br />
<br />ACORD 25 (2001/08)
<br />
<br />IHellIlER, 118 ),SfIRe ell REI"R"'9I!UTA'lWES.
<br />AUTHORIZED REPRESENTATIVE
<br />... .1- __,I _.....A. A6____.__~
<br />Sandra Marroquin/SAM ~~, r-~
<br />
<br />-------- .---------
<br />
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<br />
<br />~ ACORD CORPORATION 1988
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