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-�' , 0 11-1t�V -7 <br />A� °� CERTIFICATE OF LIABILITY INSURANCE <br />r—DATE 0 3 /30lDD/Y1 <br />03/30/2011 <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. 112111 f;' <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). _Y <br />PRODUCER OD08408 1- 415 -541 -7900 <br />Wells Fargo insurance Services USA, Inc. <br />45 Fremont Street <br />Suite 800 <br />NAMEA _ ) <br />PHONE FAX <br />A/C No Ext : A/C No <br />E -MAIL <br />ADDRESS: <br />INSURER (S) AFFORDING COVERAGE <br />NAIC # <br />San Francisco, CA 94105 <br />INSURERA: FIRST MERCURY INS CO <br />10657 <br />INSURED <br />Crown Building Maintenance Company Inc. <br />DBA: Able Building Maintenance Company Inc. <br />INSURER B: HARTFORD FIRE IN CO <br />19682 <br />INSURER C: FEDERAL INS CO <br />20281 <br />INSURER D: AMERICAN ZURICH INS CO <br />40142 <br />868 Folsom Street <br />INSURER E: COLONY INS CO <br />39993 <br />San Francisco, CA 94107 <br />INSURER F: <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 50,000 <br />U, VLMi "CL � LU4_S'IUU4 n=11i 1A \I \111 ■��c�. <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 />I TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />POLICY NUMBER <br />MM /DDY/YYYY <br />MM /DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />FMMI024933 <br />04/01/1 <br />04/01/12 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 50,000 <br />CLAIMS -MADE I X I OCCUR <br />MED EXP (Any one person) <br />$ 5,000 <br />X $10,000 SIR Each Occ <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />A <br />GENERAL AGGREGATE <br />$ 2.000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRO <br />PRODUCTS - COMP /OP AGG <br />2.000,000 <br />�,- �' <br />-�I <br />$$ <br />POLICY X r LOC <br />- <br />B <br />AUTOMOBILE <br />LIABILITY <br />57 <br />/1'1_.Q4`/01/12 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />X <br />ANY AUTO <br />` <br />mpay <br />'� ^�rA <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED SCHEDULED <br />A <br />�om7 <br />BODILY INJURY Per accident <br />( ) <br />$ <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$250 X Actual Cash <br />X <br />C <br />X <br />UMBRELLA LIAB X <br />OCCUR <br />79820671 <br />04/01/1 <br />04/01/12 <br />EACH OCCURRENCE <br />$ 10,000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />$ 10,000,000 <br />DED RETENTION $ <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />WC8298257 -08 & WC8298258 <br />0�¢ /01 /1 <br />04/01/12 <br />X WC STATU- OTH- <br />RY M <br />Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />N❑ OFFICER/MEMBER EXCLUDED? <br />N/A <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />D <br />Workers' Comp. /Employers <br />WC8298258 -08 (AOS) <br />04/01/1 <br />04/01/12 <br />Retro Program 150,000 <br />E <br />Pollution Liability <br />CPL300516 <br />04/01/1 <br />04/01/12 <br />Each Poll. Cond. 1,000,000 <br />D <br />Workers' Comp. /Employers <br />WC8298257 -08 (CA) <br />04/01/1 <br />04/01/12 <br />Deductible 350,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Job -Site: 60 Civic Center Plaza. City Of Santa Ana Police Department are named as additional insured per attached. This <br />insurance coverage is primary and non - contributory. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana Police Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Manager Caddell /Communications <br />60 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />USA <br />tV iatsts -2UTU ACURD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />editty <br />20435004 <br />