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LETI
<br />DATE (MM/DD/Y YYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 6/1/2011
<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: 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 polic7/2 e�"Iftcflikiesfroi�aylteclqi% an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER v , �($$$) $2543,22 _ v _ NAME:
<br />CONTACT
<br />Bowermaster & Associates CIT-', PHONE
<br />FAX
<br />. ESU" -_- - _(A/C..N4J _---..
<br />P.O. BOX 6026 i -+%__L i.. ,'..i,. E-MAILNo-._---_ _---. __---._
<br />10805 Holder Street -Suite 350 ADDRESS:PRODUCER _-- ----------------------------------_-- -_-- - -
<br />Cypress, CA 90630 CUSTOMER.: a: HONDCOM-01
<br />_
<br />INSURER(S) AFFORDING COVERAGE NAIC p
<br />INSURED Hondo Company,Inc. INsuRER A --Landmark American Insurance Co.
<br />2121 South Lyon Street INSURERB:Travelers Indemnity Company
<br />Santa Ana, CA 92705--- -------------_-.___ _-----.__------__----
<br />INsuRERc: RSUI Indemnity Company
<br />INSURER D: Preserver Insurance Company
<br />INSURER E
<br />INSURER F
<br />Crl\/FQ ArSFC CFOTICIC ATF IJI IMQFQ- DF\/IC 1/lIJ NI
<br />THISIS 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 />INSRsueTYPE
<br />LTR
<br />OF INSURANCE
<br />ADD
<br />SUB
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDNYYY
<br />OILICY EXF
<br />MM/DDYYY
<br />/Y
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />JCLAIMS -MADE t X I OCCUR
<br />X
<br />LHA135408
<br />6/1/2011
<br />6/1/2012
<br />PREMISES_(Ea occu ante) _$ 50.000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />X BI/PD Ded./OCC $5,000
<br />GENERAL AGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />POLICY X PRO- LOC
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />BA2AO92685
<br />6/1/2011
<br />6/1/2012
<br />COMBINED SINGLE LIMIT $ 1,000,00
<br />(Ea accitlen[)
<br />X
<br />BODILY INJURY (Per person) $
<br />_-
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />- - - -
<br />PROPERTY DAMAGE $
<br />(Per a..id—)
<br />NON -OWNED AUTOS
<br />$
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 2,000,00
<br />AGGREGATE $ 2,000,00
<br />C
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />NHA228267
<br />611/2011
<br />6/1/2012
<br />- ----- --- --
<br />- ----- -
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />(Mandatory in NH)
<br />N/A
<br />WCC001751900
<br />1/1/2011
<br />1/1/2012
<br />X WC STATU- OTH-
<br />TORY LIMITS ER
<br />E. L. EACH ACCIDENT ___ .$ - -
<br />E . DISEASE - EA EMPLOYEE $ 1.000,000
<br />If yes, tle scri be untler
<br />DESCRIPTION OF OPERATIONS below
<br />E . DISEASE -POLICY LIMIT $ 1,000.000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additl onal Remarks Schedule, if more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are
<br />named as additional insureds with W�,pg�r.Ls-tn Ge n�raL�a bifiij poFr(f9frJ%NSG15017 1207; Primary wording is included.
<br />CERTIFICATE HOLDER ✓. r- y — CANCELLATION
<br />aura Stitt Sheedy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />,t City Attorney THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />C/O Public Works Agency- The Depot
<br />20 Civic Center Plaza, M-21
<br />Santa Ana, CA 92701- 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 />
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