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<br />HOUST-2 OP ID: KZZH
<br />A<7"M6 -
<br />4111.1�CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<br />09/07/11
<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 CERTIFICAI FIRTEg _ ,
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the p0li;y(k) st be endorsed. If SUBROGATION IS 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 endorsement(s).
<br />PRODUCER,�,909-$86'9861
<br />Alliant Insurance Services,lnc i_ gpg-886-2013
<br />Llc-OC36861)
<br />735 Carnegie Drive, Ste 200
<br />San Bernardino, CA 92408
<br />CONTACT"K�nnall Goad
<br />PHONE , Ig09-474.8766 FAX
<br />AIC No Ext : ac, No): 909-886-2013
<br />E-MAIL k oad alliantinsurance.com
<br />ADDRESS: g
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />5057 -Jay Freeman
<br />INSURER A:Q B E Insurance Corp
<br />EACH OCCURRENCE $ 1,000,00
<br />INSURED Houston & Harris PCS Inc
<br />21831 Barton Road
<br />Grand Terrace, CA 92313
<br />INSURER B: Everest National Insurance Co
<br />INSURER C: National Union Fire Ins Co
<br />INSURER D: Golden Eagle Insurance Corp
<br />INSURER E:
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X PRO LOC
<br />INSURER F: WORK COMP RENEWALS ONLY
<br />$
<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 MAY 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSIR LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />R
<br />POLICY NUMBER
<br />LICY EFF
<br />MM/ DYIYYYY
<br />MMI DY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />X CLAIMS -MADE 1-1 OCCUR
<br />X
<br />GXG00875
<br />06/24/11
<br />06/24/12
<br />EACH OCCURRENCE $ 1,000,00
<br />DAMAA
<br />PREM T ELATED 50,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,00
<br />GENERAL AGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X PRO LOC
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />$
<br />D
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BA8780527
<br />06/24/11
<br />06/24/12
<br />COMBINED SINGLE LIMIT 1,000,00
<br />Ea accident $
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />C
<br />UMBRELLA LIAB
<br />X EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />BE020724673
<br />06/24/11
<br />06/24/12
<br />EACH OCCURRENCE $ 2,000,00
<br />AGGREGATE $ 2,000,00
<br />DED I X I RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITYTORY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />7600003267111
<br />09/01/11
<br />09/01/12
<br />X I WC STATU- I JOTH-
<br />LIMITS I ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT I $ 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 Additional Remarks Schedule, if more space is required)
<br />Certholder is add'I msd as respects gen'I liab per CG2016 0704 & CG2037
<br />0704. i_PPROVE'D ,' q S TO 'ORM
<br />1/3 —'d
<br />Laura S iteedy'.
<br />ASSiSWUL c- Attortic',V
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYA-1
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Water Resources AP
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />220 S Daisy Ave
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92703
<br />ACORD 25 (2010/05)
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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