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CIiF•ntiF- d5A9dA <br />?f -?OlD - D`T 2 <br />MASTELEC5 <br />ACOROT„ CERTIFICATE OF LIABILITY INSURANCE DATE (MM,°D/l'YYV, <br /> 1 O/18/20, O <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(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CE E <br />IMPORTANT: If the certificate holder is an ADDITIO L 1 D, the poll y(ies must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies m orsement. A statement on this certificate does not confer rights to the <br />ay require an end <br />certificate holder in lieu of such endorsement(s). C _ <br />(?? -- -- <br />PRODUCER F= `.;; ?". - ? `?I <br />? • L? ? ,,' i <br />? Adrienne Siqueiros <br />Hub International - ac No E:e :951 788-8500 ac, No , 95'1 231 -2572 <br />HUB InYI Insurance Serv_ Inc. n-o wless: CA001.ProcessingUnit@hubinternational_co <br />4371 Latham St, Ste #101 <br /> CUSTOMER ID #: <br />Riverside, CA 92501 <br /> INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED Travelers Property CaSUalty CO <br />INS <br />R <br />R A 25674 <br /> : <br />U <br />E <br />TSJ Electrical 8. Communications, Inc. INSURER B :Travelers Indemnity Company of 25682 <br />dba Masters Electric <br /> INSURER C <br />7490 Jurupa Avenue <br /> INSURER D <br />Riverside, CA 92504 <br /> ,!/ .?/ INSURER E <br />L'CD'- ? <br />a / <br /> " INSURER F <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 MAV 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br /> TYPE OF INSURANCE POLICY NUMBER - MM/DO E/`lYYY MM/DD EM'YY LIMITS <br />A GENERAL LIABILITY DTEC09011 P041TIL1 O 4/20/201 O 04/20/2011 EACH occuRRENCE $1 000 000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occunence $300,000 <br /> CLAIMS-MADE ? OCCUR MED EXP (Any one parson) $5,000 <br /> X PD Ded: $2,500 PERSONALBADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000 <br /> POLICY PRO LOC $ <br />B AUT OMOBILE LIABILITY DT8109011 P041 TCT1 O 4/20/201 O 04/20/2011 COMBINED SINGLE LIMIT <br />$ <br /> X (Ea accident) 1 OOO OOO <br /> ANY AUTO BODILY INJURY (Par parson) $ <br /> ALL OWNED AUTOS ??? D ? `/ L 0 ? A <br />1` Y • -.1l A ?O <br />BODILY INJURY (Per accident) <br />$ <br /> X SCHEDULED AUTOS <br />HIRED AUTOS _ ? ? <br />/ (PaOaCC denQ AMAGE $ <br /> X NON-OWNED AUTOS / ? $ <br /> _ _ $ <br />A UMBRELLA LIAB X OCCUR DTSMCUP09Q ?'j ?{?¢QT?itS„ 04/20/2011 EACH OCCURRENCE $4 000 000 <br /> EXCESS LIAB CLAIMS-MADE Y AGGREGATE $4 OOO OOO <br /> DEDUCTIBLE $ <br /> X RETENTION 1 O OOO $ <br />A WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY DTJUB8574R4621 O 10/18/201 O 10/18/2011 X `^/c STATU- OTH- <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEY/N N/A E.L. EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDEDT <br />(Mandatory In NH) <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br /> DESCRIP TON OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 <br /> <br />DESCRIPTION OF OPERATONS /LOCATIONS /VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, H moro apace la roqulred) <br />Certificate holder is named as additional insured in regards to the General Liability policy per attached <br />form CGD246 08/05. Insurance is primary/non-contributory per attached form CGD246 OS/O5. Waiver of <br />subrogation applies to General Liabilty policy per attached form CG2404 10/93. <br />GERTI FIGATE HOLDER CANCELLATION lU Ua S TOr NOn-Ya Tent <br /> <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />L'Ity Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Public Works Agency <br />PO BOX 1985, M-21 AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 '? <br />m 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#5914771/M889997 VG41