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178504 Servando Varela dba Xv Solution Certificate of Insurance <br />9 - /3 - <br />(page 1 of 1) 11/03/2010 11:35:34 AM <br />a DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 1 1 /3/20'1 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 <br />NA OIgRq,(k#T EYTYVHEN THE. ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDE ``t 1111 LL''SS f�''11��11 {{ OO <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require q.pr�Qoi ement. A^_"er An this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). i l T t-' i <br />PRODUCER <br />Techlnsurance <br />1301 Central Expy. South, Suite 115 <br />Allen, TX 75013 <br />- <br />PAHINij EH : (800) 668-7020 FnAic .):(972) 390-8484 <br />A URIESS: <br />PRODUCER <br />C T MERID#: <br />INSURERS AFFORDING COVERAGE NAIL # <br />INSURED <br />Servando Varela dba XV Solution <br />344 Orange Slossum <br />Irvine, CA 92780 <br />INSURER A : The Hartford 30104 <br />INSURER B: <br />INSURER C: <br />_ <br />INSURER D <br />INSURER E : <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 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 />iNSR <br />LTR <br />TYPE OF INSURANCE <br />A.—UBR <br />20 Civic Center Plaza - Ross Annex (M- ) <br />POLICY NUMBER <br />POLICY EFF <br />MWDD <br />POLICY EXP <br />YY MM/DD/YY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />COMMERCIAL GENERALLIABILITYPREMISES <br />CLAIMS -MADE OCCUR <br />`J <br />46SBMUV6485 <br />9/213/2010 <br />9/28/2011 <br />EACH OCCURRENCE $ 2,000,000 <br />Ea occurrence $ 300.000 <br />MED EXP (Any one person) $ 10,000 <br />PERSONAL S ADV INJURY S 2.000,000 <br />GENERAL AGGREGATE j S 4.000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />V I POLICY PRO- 71 LOC <br />PRODUCTS - COMP/OP AGG S 4,000,000 <br />S <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />S <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />APPRO VEIll <br />Tl� <br />S 1 O <br />s > h rt <br />t1i\IM <br />I <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />rs <br />BODILY INJURY (Per peon ) $ <br />BODILY INJURY (Per accident) S <br />PROPERTY DAMAGE <br />(Per accident) $ <br />S <br />'Is <br />UMBRELLA LIAB <br />EXCESS LAB <br />OCCUR <br />CLAIMS -MADE <br />aLLLa. <br />Assistant <br />ILL C y <br />Ity ALtOr <br />C}' <br />EACH OCCURRENCE S <br />AGGREGATE $ <br />DEDUCTIBLE <br />RETENTION $ <br />S <br />! $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />AN V PROPRIETOR/PARTNER/EXECUTIVEN <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />/ A <br />I WC STATiU OTH-i <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />Operations Pertainirig to named inured for certholder, City of Santa Ana and its officers, agents, mpresenta0yes, volunteers, 8 employees are adtlitional insured / prim wrtl as respects gen'1 liab per —d'ts CG7158 <br />12/038CG7253 9/06-30 day NOC expect 1Otlay for nonpayment or premium. CARRIER WILL NOT MODIFY CANCELLATION CLAUSE/NO XX OUT. <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <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 />20 Civic Center Plaza - Ross Annex (M- ) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />