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A� 1:> CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMIDD/YYYV) <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 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 Bolton & Company <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />CONTACT NAME: <br />PHONE A/C No: - <br />E-MAIL ADDRESS: <br />INSURER(SI AFFORDING COVERAGE <br />NAIC p <br />INSURER A: Travelers Propedy & Casualty Company of Am <br />www.boltonco.com 0008309 <br />INSURED <br />Merchants Building Maintenance LLC <br />1190 Monterey Pass Road <br />Monterey P/arkf 91754 <br />INSURER B : Safety NationalCorporation <br />INSURER I <br />- <br />INSURER D: <br />INSURER E : <br />MCA/ <br />�__ - Ci �',• .•7r� ,r /•,`._, <br />INSURER F : <br />t'l_. <br />L.`< <br />COVERAGES CERTIFICATE NUMBER, 12929958 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 />ADDL <br />SUBR <br />NUMBER <br />POLICPOLICY <br />MM/DDYEFF /YYYY <br />POLICY <br />M/DDT <br />LIMITS <br />A <br />GENERAL LIABILITY <br />6308043N684TIL <br />6/1/2011 <br />6/1/2012 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGEPREMISESS ( RENTED <br />Ea occurrence <br />_ <br />$ 300 000 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE n OCCUR <br />MED EXP (Any one person) <br />$ 5,000 <br />_ <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />_ <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ 2.000,000 <br />$ <br />POLICY PRO LOC <br />A <br />AUTOMOBILE <br />LIABILITY <br />810329D1831TIL <br />6/1/20.11 <br />6/1/2012 <br />COMBlNEDtSINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO? <br />-` �' A! 3' ' , . <br />+'i - <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOSAUTOS <br />- <br />� <br />/ <br />l _ _. <br />,_.. <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />c, <br />A <br />UMBRELLA LIAR <br />OCCUR <br />CUP8043N684TIL <br />6/1/2011 <br />6/1/2012 <br />EACH OCCURRENCE <br />$ 10,000,000 <br />AGGREGATE <br />$ 10,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED Lj RETENTION$0 <br />$ <br />$ <br />B <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PR0PRIE-OR/PART4EPJE ECUTIVEr j <br />OFFICERWEMBER EXCLUDED? u <br />NIA <br />SP4046075 Excess WC CA <br />( ) <br />YUB598M601112(AOS) <br />4/24/2012 <br />1/1/2012 <br />4/24/2013 <br />1/1/2013 <br />I <br />WC STATU- O�I- <br />TORY LIMITS <br />E.L.EACH ACCIDENT <br />$ 1000000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />C <br />EmplyeeTheft /Forgery <br />81585028 <br />6/1/2011 <br />6/1/2012 <br />Limit $1 MIL/Ded. $25,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />Workers Comp is Self -Insured under California Certificate of Consent to Self Insure #1793 for California operations. <br />Job: Operations of the Named Insured. <br />Additional Insured(s): City of Santa Ana. <br />CERTIFICATE HOLDER <br />CANCELLATION <br />MBM CA, Operations of the Named Insured <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 M-30) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92702-1988 <br />AUTHORIZED REPRESENTATIVE <br />Cheryl Feia <br />©1988-2010 ACORD CORPORATION. All rights reserved. / <br />ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD <br />CERT NO.: 12929958 CLIENT CODE: MERCH-1 Elizabeth Foster - Direct 626-535-1433 4/25/2012 11:42:26 AM Page 1 of 3 V�. <br />