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Client #: 1271727 kT11.i W dZq I.q rOT —U ACORD- CERTIFICATE OF LIABILITY INSURANCE """ �M 7/30/20 0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BB8,T Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Orange County HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 680 Langsdorf Drive Suite 100 A Fullerton, CA 92831 INSURERS AFFORDING COVERAGE NAIC # INSURED Lynn Capouya Inc. 17992 Mitchell South, Suite 110 Irvine, CA 92614 INSURERA: Hartford Casualty Insurance Corn 29424 INSURER B: Hartford Ins Co of the Midwest 37478 INSURERc: Hartford Underwriters Insurance 30104 INSURERD: INSURER E: $3OO OOO MED EXP (Any one person) COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN5K LTR ADD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE DATE MM D POLICY EXPIRATION DATE(MMIDDIYYM LIMITS A GENERAL LIABILITY 72SBAKN6524 07/10/2010 07/10/2011 EACH OCCURRENCE $2 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $3OO OOO MED EXP (Any one person) $10,000 CLAIMS MADE N OCCUR PERSONAL 8 ADV INJURY s2,000,000 GENERAL AGGREGATE $4 000,000 GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG s4,000,000 POLICY PRO- LOC C AUTOMOBILE LIABILITY X ANY AUTO 72UECAH1867 07/20/2010 07/20/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY (Per accident) DAMAGE $ F1 - • `, i.J i� lL lJ A 1 TO GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY OCCUR CLAIMS MADE � - (` ty y ttOrney EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 72WECRRO814 08/01/2010 08/01/2011 X WC LIMIT FR E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Cancellation clause is completed as follow: except in the event of Non Payment when a 10 day notice will be provided Certificate Holder is added as Additional Insured per pages 10 -17 of coverage form SS0008 0405 attached. City of Santa Ana Public Works Agency M -36 P.O. BOX 988 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) 1 of 2 #S5401561/M5276793 O 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TLAMS