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Policy Number: Date Entered_ 07/08 J2011
<br />'4� °_-RO® CERTIFICATE OF LIABILITY INSURANCE OATEIMM/DOJYI'VY}
<br />7JB J2011
<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 CF�L�I�ICjLlfE D �, ,
<br />IMPORTANT; It the certificate holder is an ADDITIONALINSURE D, the pollcy(i¢s) must be ®ndorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain RgUFies may require an on dorsoment. A statement. on this certificate does not confer rights to th¢
<br />certificate holder in lieu of such endorsoment(s[,. _ - � �� - - . , -
<br />PROOVCER )' �_" _ ACT
<br />BRIAN H . ZENZ SNSURP.NCE AGENCY;- INC . 9M€; -
<br />PHONE. (999) 833 -1541
<br />4000 Sirch Street #115 - 1�- NC.._Extl: �- ___ ,_......... t.a c, NO)� (949)260 8080
<br />Newport Beach, CA 92660 AoogESS. Pam @x ®nz in surance. com - -- --
<br />INSURER(5) AFFORDING COVERAGE - NAIG b
<br />- INSURER A, SCOttsdalB In9vranCa COmp8ny -
<br />INSUasD Orange Count _Co t t _._.
<br />y n rac or $ @rv1 CO3
<br />INSURER B:State CURp9n9 at3 nn Sn9v IIance -Ft1nd
<br />-
<br />6 Orange County Mailboxes
<br />wsu RER C:...... _._. _....... __..
<br />_...
<br />Edward Scha de 6 Jody Adams DBA:
<br />_..
<br />1810D Kovac Drive #27
<br />� INSURER D.,...
<br />_.. __.
<br />_....
<br />Huntington Beach, CA 92648
<br />INSURER E _.. _.
<br />_
<br />COVERAGES CERTIFICATE NUMBER:
<br />INSURER F:
<br />THtlS IS TO CERTIFY THAT" THE POLICIES OF INSURANCE
<br />REVISION NUMBER:
<br />LISTED BELOW HAVE BEEN ISSUED TO THE INSV RF..D NAMED ABOVE FOR THE POLICY PERIOD
<br />IND2C ATED.. NOTWITHSTANDING ANY REOUIR EMENL TERM OR CONDITION
<br />C E_RTIF ICRTE MAY BE ISSUED OR MAY PERTAIN, TH F_ INSURANCE AFFORDED
<br />OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPF_CT
<br />BY THE POLICIES DESCRIBED "T
<br />TO WHICH 'i'HIS
<br />EXCLVSIONS AN❑ CON Ull 10 NS OF SUCH POL ICIES LIMITS SHOWN MAY HAVE
<br />HEREIN IS SUBJ F..0
<br />BEEN
<br />TO ALL TFiE TERMS.
<br />INSR -. ____.
<br />AOOL'SUBR
<br />LTR TYPE OF INSURANCE
<br />.. NSR ` {M /D PO CY U BER
<br />RED UC:ED BY PAID CLAIMS.
<br />-- ......
<br />PO LICYEFF POLJCY E %P
<br />'.
<br />-_ -'
<br />_
<br />GENERAL LIABILITY
<br />FMM/ODMYYYI fMMID YYY LIMITS
<br />- _,
<br />A
<br />%�L'OMMERCIAI. GENERAL LIABLLITY - !CP$13"T7665
<br />'
<br />EACH OCCURRENCE
<br />GS /2T /2Di1 0512'1 /2012 DAMAGE T'D REN7F'O
<br />�- §1, 0OO OOO.
<br />C'JUMS -MAUL X GCCiJR �.!�
<br />PREMISES (Ea pepurrsrvca)
<br />S 100,000
<br />MEU EXP (Any ne L ration)
<br />g 5 , 000 .
<br />',.
<br />'. _PER50NALBADV INJURY
<br />-,3� -. pDD, ODp
<br />_.
<br />GENL ArGRCG LIMIT APF'UCS PFR
<br />...GENERAL AGGREGATE
<br />32, 0OO, OQO.. _.
<br />\A/I!F
<br />, PRO_
<br />' PKODUCY -5 COMP /OP ACdG
<br />$1, pDD. OOO.
<br />POItCY / \: ' T ' LOC
<br />__
<br />_
<br />_ .._'. .- .. _._
<br />AUTOMOBILE LIABILITY - '.
<br />__.
<br />""
<br />S._
<br />ji -
<br />I. LOMHINEO SINGLE LIMIT
<br />(Ea accldant)
<br />_
<br />§1 r 000 , 000 _
<br />. ANY At /TO !CP$1 $77665
<br />I- __...._ _ __
<br />Al k.:JVJN D SG YEDUI FP
<br />AVTOS __ AVTOS
<br />NON -OWNED
<br />%�
<br />OS ?27 /2011 OS /2 T/2012 UOOIIY INJURY(F Of pars �n)
<br />'. ___
<br />pOUILY INJURY Lf`rnr at`LL1nn!)
<br />§
<br />$
<br />b11RCD AU OS
<br />�- e__.... .- AUTOS
<br />PROPERTY tYAMAGF
<br />` -_
<br />� _
<br />UMBRELLA LIAR :
<br />i OCCUR
<br />�
<br />5
<br />._...
<br />' _ --' '�, EACH OCCUR RE NC`E $
<br />E %CESS LIAR i L'LAIMS MADE
<br />$
<br />�.... DEU 7___- RF rENTlO 5 � ACCREGATC _... _
<br />: WORKER$ COMPENSATON ' "- --' ' $ _
<br />AND EMPLOYERS' LIABILITY ' � WC S "I'AiU OT11 -
<br />ANY PKOPRIETORfPART NE R/E XE ^,U'fNE Y/N rVRYyIMljS _ ER
<br />B OFFlCRlMEMBER EXGLUDErY? � -N /A'. 1962456 06 /UG J2U11 (J5 /OL /2012 FL EACH ACCIDENT §1, pp0, DDD-
<br />: (Mandatory In NHI _ _.
<br />If yys d95Cnbe unUaf E.i DISEASE. FA EMVI_VYEE $1. ODD, DOp,
<br />DESCRIPTION OF OPERA "I "IONS beivw �' - E.1_ bISEASC - POLICY LIMIT S 1 O D D , D D 0 -.-
<br />-
<br />DESCRIPTON OF OPERATONS : LOCATIONS /VEHICLES (Alta cM1 ACORO 101 Atlditional Ramarl(a Schedule, II mor pacs fs rogWrotl) - "`
<br />30 day notice a£ can calla tion except on -pay, than 10 days applies _ Blanket additional insured #CG20330704
<br />primary /non - contributory workding #GL529s (07/08), waiver of subrogation #CG24041093 along with per project
<br />aggregate #CG2503 3 -97 included as part o£ general liability policy.
<br />The Ci T_y o£ Santa Ana, its o££icers, employees, agents, vo hint ®ere and representatives era addi ti anal
<br />insured per company Forms listed above and city's Form, attached.
<br />CERTIFICATE HOLDER CANGELL.ATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED @EFORE
<br />City of Santa Aria � ? THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />�� ��_� �___ _ ACCORDANCE WITH 7HE POLICY PROVISIONS.
<br />x�,.rblao wor)ca Rgan °y Laur it( Speedy --
<br />220 S.. Daisy Ava. M —BS gUTHORIZEO REPRESEI/Y�ATVE
<br />Banta rma, cA e27D2 /'�snis tar City AtTorn e�/ �, w � /
<br />f�� /
<br />Amon oc for..nrn �.
<br />O 7988 -20'10 ACORD CORPORATION_ All rights reservBd.
<br />- . -- - -� - -r ...� .- .....r«. name anD logo are registered marks o9 ACORD
<br />FmU�•ced umn3 F'orr.}s Roxs Plus snrtwarn. w�ww.FOfmsBOSa.ao.n: Imprne�rve Pubi�shm® 8G0.20k ? -T9?7
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