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178504 Servando Varela dba Xv Solution Certificate of Insurance <br />/U - 2"0 y - Z3 2 <br />(page 1 of 1) 11/03/2010 11:35:34 AM <br />(MM DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE DATE 11/3/2010 <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 CONSTITUTEA 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 pollcy(les) 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 Ileu of such endorsements . <br />PRODUCER <br />TachlnsurancePHONE <br />1301 Central Expy. South, Suite 115 <br />Allen, TX 75013 <br />NONT CT <br />E- <br />_(800)668-7020 FAX <br />A/c No : (972) 390_-6484 <br />-MAIL <br />PRODUCER <br />CUSTOMER <br />INSURERS AFFORDING COVERAGE MAIC V <br />INSURED <br />Servando Verela dba Xv Solution <br />344 Orange Blossum <br />Irvine. <br />Irvine, CA 92780 <br />INSURER A: The Hertford 30104 <br />INSURER B: <br />- <br />INSURER C: <br />INSURER D <br />INSURER E • <br />INSURER F : <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 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 />ILTR <br />TYPE OF INSURANCE <br />ADD <br />POLICY NUMBER <br />MSD Y EFF <br />POLIIMMI.CY EXP <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE 5 2,000A00 <br />17MER 'ALGENERALLIABILITY <br />CLAIMS -MADE O OCCUR <br />- <br />PREMISES Es occumenra $ 300.000 <br />MED EXP (Arty one person) 5 10.000 <br />PERSONAL&ADVINJURY 5 2.000.000 <br />A <br />4eSBMWS485 <br />RMW2010 <br />9/28n011 <br />GENERALAGGREGATE 5 4.000,000 <br />GEN'L AGGREGATE LIM IT APPLIES PER: <br />PRODUCTS -COMP/OPAGG S 4.000.000 <br />I POLICY PRO- LOC <br />5 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT S <br />(Ea a IC .t) <br />BODILY INJURY (Per person) 5 <br />ALL OWNED AUTOS <br />BODILY INJURY (Per ecFdml) 5 <br />SCHEOULEDAUTOS <br />HIREDAUTOS <br />yl1OVE',i� <br />-l TO <br />\n <br />PROPERTY DAMAGE 5 <br />Pa acciden <br />5 <br />NON-0WNED AUTOS <br />� <br />UMBRELLA UAB OCCUR <br />au TU <br />itt .G: C.y <br />EACH OCCURRENCE 5 <br />EXCESS LIAB CLAIMS-h1ADE <br />"Assistant. C. <br />It, A(l01'r'C}` <br />_ <br />AGGREGATE 5 <br />DEDUCTIBLE <br />S <br />5, <br />RETENTION S <br />WORKERS COMPENSATION <br />VIG STATU- OTH- <br />AN DEMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR/PARTNERIEXECUTIV E <br />OFFICERIMEMBER EXCLUDED] <br />N f A <br />E.L. EACH ACCIDENT 5 <br />EL. DISEASE - EA EMPLOYE S <br />(Mandatory In NH) <br />II'yyaS describe Under <br />OF OPERATIONS OeW,v <br />E.L. DISEASE - POLICY LIMIT 5 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS [VEHICLES (ANach ACORD 101, Additional Remarks Schetlule, if more apace la requlmd) <br />Operatbns perlalnirig [o nert,etl loured /or certhdtler. Cw-ty of Santa Ana eM its olRcere, agents, rapresenta uvea, votuntaers, 8 empbyees era atldi0onal Ensured /prim wrd as raspacls 9enl Ilab per entl'ts CG]t5B <br />12103&C07263 9/05'30 day NOC expect 10day far nonpayment or premium. CARRIER WILL NOT MODIFY CANCELLATION CLAUSEINO XX OUT. <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE <br />WILL BE DELIVERED IN <br />20 Civic Center Plaza - ROSS Annex (M- ) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD <br />