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R-IRANC <br />ACORDTm CERTI ATE OF LIABILITY IN El <br />-;?0/0 oy <br />DATE M1MD - <br />10/1812 10 <br />........ . . . ....... <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 'ONLY Y 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 DR I RGDUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONA L INSURED, the policy(ies ) must be endorsed. If SUBROGATION IS WAIVED, ED, subject <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 />Ru' <br />wn <br />HUB B irt�l Insurance �"�' e Imo. Inc. <br />4371 Latham St, Ste #101 <br />Riverside, CA 9250 <br />NME: Adrianna Sigueiros <br />PHONE 941788-8500 M(, Nt� : ��' � �' ����� <br />� « <br />��F.-MAIL � � <br />ADDRESS: �A�� �,�r�Ce�� r���n t� ' b�nt�Tnatl�ri���C� <br />PRODUCER <br />CUSTOMER <br />CUSTOMER CUSTOMER ID <br />IN,SURE!!(S) AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER A • Travelers Property Casualty Co <br />25674 <br />TSJ Electrical & Communications, Inc. <br />INSURER e ; Travelers Indemnity Company of <br />_ <br />25682 <br />dba Masters Electric <br />7490 Jur�upa Avenue <br />Riverside, CA 92594 <br />INSI RER c <br />$30%000 <br />' INSU ER D <br />X COMMERCIAL, GENERAL LIABILITY <br />CLAIMS-MADE Ej� OCCUR <br />INSURER E <br />INSURER F: <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 />SR <br />TYPE OF INSURANCE <br />P3DLRB <br />POLICY NUMB <br />MMID© EFF <br />P M.[�G'� YYR <br />Lll rrS <br />A <br />GENERA . LiABIL�TY <br />DTECO9011 PO41 TILL O <br />2012010 <br />0412012011 <br />EACH OCCURRENCE <br />$110002000 <br />PREMISES Ea otrrenSc a <br />$30%000 <br />X COMMERCIAL, GENERAL LIABILITY <br />CLAIMS-MADE Ej� OCCUR <br />MED EXP (Any one persm) <br />$5,000 s <br />PERSONAL & ADV INJURY <br />$1,0001000 <br />X PD Ded: $2,500 <br />GENERAL AGGREGATE <br />s2,000,0 <br />PRODUCTS - COMP/OP AGG <br />s2,000,000 <br />CEN`L AGGREGATE LIMIT APPLIES PER: <br />I <br />PRA- LOC <br />POLICY <br />D <br />�L <br />AvT0MOBILE L "UTY <br />X AMY AUTO <br />DT81 09011 P941 TCT1 0 <br />04/2012010 <br />0412012011 <br />COMBINED SINGLE LIMIT <br />Ea axIcer�t) <br />(Ea <br />1500010 0 <br />11% URY (Per perrx) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />X HIRED AUTOS <br />A <br />T FORM <br />; BODILY INJURY (Per <br />PROPERTY DAMAGe <br />(Per accident) <br />X NON -OWNED AUTOS <br />A� <br />UMBRELLA uAB <br />X <br />OCCUR <br />DTSMCUP09�'�ftWT t <br />� <br />04120120111 <br />EACH OCCURRENCE <br />$40 fain <br />I AGGREGATE <br />s470003000 <br />EXCESS LIAR <br />CAMS -MA 3E <br />DEDUCTIBLE <br />_ <br />$ <br />$ <br />5XIRETENTIO.N....19 <br />09 <br />� <br />A <br />1r DER CCI IPEN AT ON <br />AND EMPLOYERS' LIABI'L1TY YIN <br />ANY PROPRiETORIPARTi ERIEXECL TCVE <br />OFF'ICERIMEMBER EXCLUDED? � <br />(Mandaoxy In NH) <br />! MIA <br />DTJUBB574R4621 <br />1 1118120/0 <br />1011 812011 <br />XC WC STATt� faTF - <br />E.L. EACH ACCIDENT <br />$11000,1000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />6RIPTIIOM OF OPERATIONS below <br />D�S �7F <br />E.L. DISEASE - POLICY LIMIT <br />$15000,000 <br />- <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES 4nach ACS 101, Additional Remarks Schedule, If rmre space Is required) <br />Certificate holder is named as additional insured in regards to the General Liability policy per attached <br />farm CGD246 08105, Insurance is primarylnon -contributory per attached form CGD246 08105. Waiver of <br />subrogation applies to General L.iabilty policy per attached form CG240410193. <br />CERTIFICATE HOLDER- CANCELLATION 10 Days for Non- Favment <br />............................. <br />City of Santa Ana <br />Public Works Agency <br />PO Box 1988, M -21 <br />Santa Ana, CA 92702 <br />ACORD 26 (2009109) 1 Of 1 <br />#S9147711M889997 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE <br />THE ItXPIRATION DATE THEREOF, NOTICE VVI LL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />1988 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORN <br />`G41 <br />