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A?R&' CERTIFICATE OF LIABILITY INSURANCE DATE MMIODP(YYYj <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 CERTIFICATE HOLDER. <br />IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must 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 Patriot Risk & Insurance Services CONTACT NAME: <br />8105 Irvine Center Drive #400 <br />Irvine, CA 92618 <br />PHONE wc.No,Exo: (949) 486-7900 'PAX (AID, Not: (949) 486-7950.. <br /> E-MAIL ADDRESS: <br /> INSURER(S) AFFORDING COVERAGE NAICk <br />wvrw.pairisk.Carn. _ 9665454.._... INSURERA: Old.Repubhc Construction. , 24139. <br />IN UREO <br />rest+ga Str(pin Services, Inc. <br />1054 Railroad treat INSURER B: i. <br /> <br />INSURER C <br />Corona CA 92882 111-0190 0 -0-i/y INSURER D <br />{ <br /> INSURER E : <br /> INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 16 63079 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 />INSH' {ADOLSUBRi <br />LTR TYPE OF INSURANCE I ... ... POLICY EPF POLICY E%P. <br />POLICY NUMBER I Y i LIMITS <br />1 GENERAL LIABILITY 1 <br />EACH OCCURRENCE IS <br /> <br />GOMMERGIAL GENERAL LIABILITY DAMAp6?'E TO RENTED <br />PREMISES(Ea oeeurmneo) !S <br />CLAIMS MADE I.........I OCCUR MEG EXP(An, one person) ITS <br /> PERSONAL S ADV INJURY IS... <br />i .. .... '.. i I I GFFIERAL AGGREGATE (S <br />G_GN'L AGGRCGAT_E LIMIT APPLIES PER. <br />I PRC)• PRODUCTS COMPIOP AGE -I <br />F Qy? <br />P <br /> <br />POLICY <br />LOS <br />IFCT <br />...._.? <br />AJ <br />S _ <br />A 01 <br />..._._ .d TO <br />AUTOMOBILE LIABILITY V INE D SINGLE LIMIT S <br />aCcj <br />A L <br /> <br />_i ANY AUTO BODILY INJURY (Per person{ S <br />AL L OWNED SCHEDULED <br />{iAUTOS !AUTOS - <br />---?"'"BODILY INJURY (Par acGtlenp l$ <br />•.?,,,y, <br />HIRF.U AUTOS NON.O`AMLD <br />AUrOS j She <br />w,,,..?-• C?'tyegCl? Pf`OPERTY DAMAGE <br />atlfa Stitt (Por accldeng_ _ S <br />t <br />' <br /> l <br />istant City Attorney <br />S <br /> Ass <br /> <br />UMBRELLA LIAR OCCUR % EACH OCCURRENCE IS <br />EXCESS LIAB <br />CLAIMS-MADE AGGREGATE $ <br />,. <br />I UED ` _! RETENTIONS S <br /> <br /> S <br />A WORKERS COMPENSATION <br />' AIC,W06191300 611/2013 16/1/2014 ? rDaY LIAMPE OEt?I- <br />IANDEMPLOYERS <br />LIABILITY YIN -, - <br />ANYPROPRIETORIPARTNERIEXECUTNE Et EACH ACCIDENT $ 1 <br />000 <br />000 <br />D NIA <br />OPFICERIMEMBER EXCLUDEOT <br />l (Mantlatory In NIh , <br />, <br />- - <br />r 1 EL DISEASE PA EMPLOYEE! S <br />1,000000 <br />Dunder <br />DESCRIPTION OF OPERATIONS bHOw , <br />EL DISEASE POLICY LIMITS 1,000,000 <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks SCnddule, If mom apnea la roqulmd) <br />30-days notice of cancellation / 10-days for non-payment of premium. <br />CERTIFICATE HOLDER NDPI I ATION <br />CA <br /> , <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Attn: Rock Garcia ACCORDANCE WITH THE POLICY PROVISIONS. <br />305 E. 4th Street Suite #201 <br />Santa Ana CA 9'2701 AUTHORIZED REPRESENTATIVE <br /> <br /> <br /> k <br /> Leonard E. Ziminsky <br />©1998.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />li ?z1 "t i issued certificates. <br />ILkFiin ccxtil'1' cate"cane, s -ans°siipe'x.lec le ". I p '- y