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ACORE® CERTIFICATE OF LIABILITY INSURANCE412519012
<br />`....�'"
<br />DATE(MM/DD/YYYY)
<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 />www.boltonco.com 0008309
<br />CONTACT NAME:
<br />PHONE No 7 FAX Arc No: 1 25
<br />E-MAIL ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Golden EagleInsurance Corporation
<br />INSURED
<br />Merchants Landscape Services, Inc.
<br />1190 Monterey Pass Road
<br />Monterey Park CA 91754
<br />4 ..- QC' i ,? I
<br />1 (�,/
<br />INSURER B : St. Paul Firein Insurance Company
<br />INSURERC: Safety National Casualty Corporation
<br />INSURERD: Federal Insurance Company
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 12930851 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 />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />,/
<br />CBP8699930
<br />7/1/2011
<br />7/1/2012
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED PREMISES PREMISES Ea occurrence
<br />$
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL 8 ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLICY JFQT PRO l/ LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BA8690031
<br />7/1/2011
<br />7/1/2012
<br />Ea a..,den,SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$er
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS e AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />`�.�$� �J r,, < .- .. '. 1
<br />•" ( 1 f.ti..0'1.
<br />accident) BODILY INJURY (Per
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />r
<br />B
<br />UMBRELLA LIAR
<br />/
<br />OCCUR
<br />QK04501208
<br />7/1/2011
<br />7/1/2012
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />AGGREGATE
<br />$ 6,000,000
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />DED RETENTION$0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N 1 A
<br />SP4046075 Excess WC (CA)
<br />4/24/2012
<br />4/24/2011
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<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 />A
<br />Employee Theft / Forgery
<br />Business Personal Property
<br />Business Income/Extra Ex n EDP
<br />81585028
<br />CBP8699930
<br />6/1/2011
<br />7/1/2011
<br />6/1/2012
<br />7/1/2012
<br />Limit: $1 MIL/Ded. $25,000
<br />Limit: $5,000/Ded. $1,000
<br />BUEE 1 � EDP $5.000/Ded. $1,000
<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 #03-1-1793-01 for CA operations.
<br />Blanket GL Additional Insured per attached, only if required by written contact.
<br />GL Primary Wording applies per 22-111 01/07 attached. Job: #3011, City of Santa Ana Parks.
<br />Additional Insured(s): City of Santa Ana, its officers, agents, employees, representatives, and volunteers.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />MLS CA, #3011
<br />City of Santa Ana
<br />Attn: Clerk of the City Council
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Cheryl Feia
<br />©1988-2010 ACORD CORPORATION. All rights reservetl.
<br />ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD
<br />17 1f q1 —TRMT (V Pi MF.DrU-t Fl ivah.th Fncr.r - nir.nf F79- 1 -1G11 d//11-S1.1G L Dan. 1 of 4
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