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Client #: 458248 <br />MASTELECS <br />ACORCSr,. CERTIFICATE OF <br />LIABILITY INSURANCE <br />DATE (MM /DD/1'YYY) <br />5/11 /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, <br />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 THEj6 T, +({AT�H � <br />Ems_ 1 � <br />IMPORTANT: If the certificate holder is an AD O A � INS RE he po Ic (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 endorseme 6 : � � - �- <br />� +.1 t <br />PRODUCER If) � <br />Hub International �' <br />HUB InYI Insurance Serv. Inc. <br />4371 Latham St, Ste #101 <br />Riverside, CA 92501 <br />' - <br />AME: Kristie Martin <br />ac °Nt'IEq Ea , 877 825 -2681 ,,'4XC, Nq ; 951 231 -2572 <br />nooRless: CA001. ProcessingUnit @hubinternational.co <br />CUSTOMER ID #: MASTELECS <br />INSURER($) AFFORDING COVERAGE <br />NAIC a <br />INSURED <br />PERSONALBADV INJURY <br />INSURERA: TraVele rS Indemnity Company Of <br />256$2 <br />TSJ Electrical S Communications, Inc. <br />GENERAL AGGREGATE <br />INSURERS: Travelers Property Casualty Co <br />25674 <br />dba Masters Electric <br />$2,000,000 <br />S <br />7490 Jurupa Avenue <br />Riverside, CA 92504 <br />AUTOMOBILE <br />INSURER C <br />INSURER D <br />DT8109011 P041 TCT11 <br />4/20/2011 <br />04/20/201 <br />_ <br />N � �J � _ � <br />$1 000 Q00 <br />INSURER E <br />BODILY INJURY (Per person) <br />INSURER F <br />BODILY INJURY (Per accitlen[) <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 MAV 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 BV PAID CLAIMS. <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MM/DD E/1'YYY <br />MM/DD/ WPY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />X PD Ded: $2,500 <br />DTEC09011 P041TCT11 <br />4/20/2011 <br />04/20/201 <br />EACH OCCURRENCE <br />$1 OOO OOO <br />PREMISES Ea occurrence <br />$3OO OOO <br />MED E %P (Any one person) <br />$5,000 <br />PERSONALBADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO LOC <br />PRODUCTS - COMP /OP AGG <br />$2,000,000 <br />S <br />A. <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />DT8109011 P041 TCT11 <br />4/20/2011 <br />04/20/201 <br />COMBINED SINGLE LIMIT <br />(Ea accitlent) <br />$1 000 Q00 <br />x <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accitlen[) <br />$ <br />PeOr a citlentDAMAGE <br />$ <br />X <br />X <br />$ <br />B <br />�( <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />DTSMCUP9011 P041TIL <br />4/20/2011 <br />04/20/201 <br />EACH OCCURRENCE <br />$4 OOO OOO <br />AGGREGATE <br />$4 OOO OOO <br />DEDUCTIBLE <br />RETENTION 1 O OOO <br />$ <br />X <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVEY /N <br />OFFICER/MEMBER EXCLUDED? <br />(Myandatory In NH) <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />DTJU68574R4621 O <br />1 O/1 $/201 O <br />1 O/1 $/2011 <br />X WC STATD- GTH- <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule. N more space Ie raqulred) <br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are additional <br />insured in regards to the General Liability policy per attached form CGD246 08/05, primary and non <br />(See Attached Descriptions) <br />CERTIFICATE HOLDER CATION <br />APPRO <br />('.Ity Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza / THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN <br />Santa Ana, CA 92701 _ L., Y �— ��ANCE WITH THE POLICY PROVISIONS. <br />` Pi [ �, r ; AYTHORIZED REPRESENTATIVE <br />.4 ��1�lat :; %- l�{ly <br />01998 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) 1 Of 2 The ACORD name and logo are registered marks of ACORD <br />#S 1172908/M 1155254 KM44 <br />