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<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 ~ DATE [MMJOOJ'{'('{Y)
<br />PACI-12 04/15/08
<br />PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ISU Insurance Services- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />The Roger stone Agency HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />5015 Birch street ALTER THE COVERAGE AFFORDED BY THE POLICIES 8ELOW,
<br />'-- Newport Beach CA 92660
<br />Phone: 949-757-0270 Fax:949-757-0375 INSURERS AFFORDING COVERAGE NAlC #
<br />INSURED INSURER A scottsdale Ins. CO.
<br /> INSUREr< B Liberty Surplus Ins. Corp
<br /> pacific Systems Elect%ic, Inc. INSURER C Mercury Casualty Co 11908
<br /> Earl Jones
<br /> 38330 Via La Paloma IIf\SU~ERD
<br /> MUrrieta CA 92563 IINSIIRERE
<br />
<br />II 1L{'7 -1~
<br />6
<br />
<br />~
<br />
<br /> THF POLICIES OF INSLflANCE LI::;TEU BELOW r-AV;:: BEEN ISSUfD TOTHF.: I~SLRED ~M:D ABOVE F:)RTHE POLICl' PERIOD INCICATED I,OlYVITHSTANDING
<br /> ANY REQUIREMENi", TERM OR C:)NDITON CF ANY CONTRACT OR OTHER DO:;'JMENT WITH RESPo:CT TO Wrl;Cr TJ-IS CERTIFICATE MAY 3E ISSUE~ O~
<br /> Wi. Y PERTAIN THF IN~RANCf AFf(;R':)EO f1Y ll-1F PO IC':IFS OESCRIRETl HEREIN IS SUBJECT TO Al_L THE lFRMS, EXC":LUSIONS AND r.m~D!Tl:lNS (F SUCH
<br /> P;:l1CIE3 ASCRt.0hTF '..Il.1ITS 3-10WN MAY HAVE BEF:-.J REDJCED BY PAID CLAlt/lS
<br /> '''i'fFw,~ I "8k~Y{MMib1YiYJ - -
<br /> LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE (~IDDNY) LIMITS
<br /> ! I GENERAL L1ABILllY EACH :)CCURRENCE $1,000,000
<br /> A X 'Xl CUMMERCIAL GEM:AA_ L1ASI' ITV CLS1463704 02/02/D8 02/02/09 PRE'MISES(Eaoccu-encel , 5D,000
<br /> ~_ CLAIMS MA.CE [!] OCCUR, MED EXP [~one person) , 5,000
<br /> A ~owner/cont Proto CLS1463704 02/02/08 02/D2/09 PERSCNA:.- & ADV INJURY $1,000,000
<br /> A X Blk' t AI, p_rim/N" CLS1463704 02/02/08 02/02/09 GENERAL AGGREGAII:: '2,000,00_~
<br /> GC::~'J'LAC('REGATE liMIT APPLIES PER PRODJ:::TS - COMPJOP AGG $2,000,000
<br /> Xl, --; >RO- n l!:llIp Ben.
<br /> X P:JUCY, JEeT lOC None
<br /> AUTOMOBilE lIABILI"TY CO~BINEC SINGlELlMT
<br /> C X =1 ;YAcCO AC11063947 02/01/08 D2/01/09 (F1'I1iIccidElf1t) $1,000,000
<br /> . ALL ovmEC AUTOS BODIL'IINJURY
<br /> ~ sceECU','O AlfTOo (Per person) ,
<br /> HIRE)N.;TOS BODilY INJURY
<br /> NJ~OW"'ED AUTOS (f'eraccidentl ,
<br />\. -i PROPERTY DAWAGE ,
<br /> (Perawdentl
<br /> GARAGE LIABILITY AUTO ONLY EAACCIDENT ,
<br /> ~ AWAUTO i NOT COVERED OTHER THAN EAACC ,
<br /> AUTO ONLY NO" ,
<br /> , E::XCESSIUMBRE::LLA LIABILITY i EACH OCCURRENCE $4~~OO,OOO
<br /> IX I OCCLR ~ r:lAIMS MACE --
<br /> A Ix C'--' XLS0048026 02/02/08 02/02/09 WGREGAE , 4,000,000
<br /> ,
<br /> .XlOfL\lIr'TI8l" I 1 ,
<br /> I c"'-I -- --
<br /> I 'I RE~E~:TION 110,000 ,
<br /> I WORKERS COMPENSATION AND h~~ t:~iT~ I I OJ~
<br /> EMPLOYERS' LIABILITY
<br /> ANY PR8PRIETORfPARTr>.ER1EXECl..JTVE E L EACHA::CiDENT ,
<br /> , OFFICE~EM8ER EXCLLOED? E l DISEASE EA EMPLOYEE ,
<br /> IfyeS,dp.scribeund8r
<br /> SPEC IAL PRO'of IS' ONS belr)'N ~L. DISEASE - POLlC) LIMIT ,
<br /> OTHER
<br /> B Pollution Liab. UBESF101763018 02/02/08 02/02/09 Per Oec. 1,000,000
<br /> , Aggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATlONS !VEHICLES I EXCL.USIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br /> RE: Electrical work - 20 Civic center Plaza, Santa Ana CA
<br /> Certificate Holder is named Additional Insured with primary and non-
<br /> contributory wording per fODll CG20100704 attached.
<br /> *10 day notice of cancellation for non-payment of premium.
<br /> **Revised - this certificate replaces certificate issued on 2/28/08**
<br />
<br />COVERAGES
<br />
<br />ACORD 25 (2001108)
<br />
<br />
<br />CANCELLATION
<br />CITY SA9 SHOULD Am OF THE A.BOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THelEOF, THE ISSUING INSURER WILL ENDEA.....OR TO MAIL * 30 OAYS'M'mTEN
<br />tlOTlCE TO THE CelTFICATE HOLDER NAf'oEDTO nlE LE::FT, BUT FAILURE TO DO SO SHALL
<br />IMPOSE NO OBLIGATION OR LIABilITY OF A'N KINO UPON nlE INSLRER, ITS AGENTS OR
<br />',J: ,RllPRESENTATlVES,
<br />
<br />~RB{;)TlW=
<br />
<br />CERTIFICATE HOLDER
<br />
<br />
<br />city of santa Ana
<br />Building Maintenance Div.
<br />20 Civic Center Plaza
<br />P.O. Box 1988
<br />Santa Ana CA 9'(1702'
<br />
<br />@ACORDCORPORATION1988
<br />
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