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.�'� ^� ® Policy Number: Date Enteretl: 07/08/2031
<br />A� RL7 CERTIFICATE OF LIABILITY INSURANCE OATE,MNII °GIYVYYi
<br />7/e/2D11
<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 INS URER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE GF�t�IkIC�1fE DHR.+ �_ . �
<br />IMPORTANT; If the cartificatB holder is an ADDITIONAL INSURED, tha�polic (ies) must ba endorsed. li SUBROGATION IS WAIVED, subject to
<br />thB terms and conditions of the policy,. certain jp2gli.Fles may req uira an Bn dorsom ant. A statement on this certiflcata does not confer rights to the
<br />certificatB holder in lieu of such endorsement(sL. -'' -
<br />PR000CER ( � -- �. - -
<br />BRIAN H _ ZENZ SN SiJR.ANCE AGEYVCY �- INC . � NJYMEA T
<br />4000 Birch Stra@t #115 1A[4 �ifn_.EIIL: (949) 833 -1541
<br />EMAIL ... - -.... . -SA�. NOI (949)260 SOHO
<br />Newport Beach, CA 92660 wboRESS. Pam@xenzlnsurance. com
<br />OESCRIPTON OF OPERATON$ f LOCATIONS I VEHICLES (Alta cb ACO R° tb1, Additional Ramarlts ScN ad ula, Ir mere s ca fa ragylrotl>> '�
<br />30 day notice of cancellation except on -pay, than 10 days appf ies_ Hlanket additional insured #CG20330704
<br />primary /non - contributory workding #GLS29s (D7 /OH) waiver of subrogation #CG24041093 along with per project
<br />aggr @gate #CG2503 3 -97 included as part of general liability policy -
<br />The City of Santa Ana> its officers, employees, agents, vo lun toers and rep re san to fives era additional
<br />insured par company forms listed above and city's form, attach ®d.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOVED ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ff//yy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />f �,
<br />City of Santa Ana � � � —��`K �/� ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Pub lie wot -)cH Ags:' °y Laur ttC Shccdy
<br />220 S .. Daisy Ave. M -BS � AUTHORIZE° REPRESE ATIVE /
<br />Banta Ana, cA 927oz �'- »Ester C.i(y ALtorne�/ �,� �,.- / /�� J
<br />Jv"' - - -_ � '-
<br />�© 1988 -2010 ACORD CORPORATION. All rights reserved_
<br />A rill � rl 1
<br />- .- -' - - -. . L� "ra��rcv name anD logo are registered marks of ACORD
<br />. rrr�ocetl �s ny F'on =y� R<a »s Plus snflwnre. www.FCrmsRCas.am>. ImPreasive Pubasning SGO- ?OH -:9 %�
<br />INSURER($) AFFORDING COVERAGE _
<br />NA)C y
<br />INSURERA SCO it9da16 =nHilran Ce COmp Bny
<br />IN SU REb Orange COUn ty COn tra CCOr SerV1 C05
<br />State
<br />CUmpgn9 ation Sn9v ran Ca Rand
<br />INSURER B
<br />S Orange COUnty P1c'ailboX @S
<br />_.. _...
<br />INSURER C:
<br />Edward SchadEt 6 Jody Adams DBA:
<br />,...
<br />18100 Kovac Drives #27
<br />� INSURER n.,...
<br />_...
<br />Huntington Heach, CA 9264H
<br />wsu RERE
<br />__
<br />-
<br />COVERAGES CERTIFICATE NUMBER;
<br />INSURER F
<br />THIS IS 70 GER'TIFY THAT THE PUU CIES OF INSURANCE
<br />REVISION NUMBER:
<br />LISTED BELOW
<br />INOlGATE D. NOT\NITHS'rA NDING ANY REOUIR EMENT.
<br />HAVE BEEN ISSUED TO -THE INS'V RF..D NAMED ABOVE FOR
<br />THE POLICY PERIOD
<br />TERM UR CO NUITION
<br />C ER 1'IFICATE MAY BE ISSUED OR MAV PERTAIN,
<br />OF ANY CONTRACT UR OTNER DOCUMENT "' WITH RESPF_CT
<br />TO YVFIIGH T "FITS
<br />TH F_ INS URAN GE AFFUROED BY THE POLICIES DESCRIB EU NEREIN IS SUBJECr
<br />EXCLIJSIUNS ANU CONDII IONS OF SUCH POLICIES. LIMITS SHOWN MAY
<br />TO ALL TN F_ PERM S,
<br />IN$R' _.
<br />HAVE HEEN REDUCED BY PAID CLAIMS.
<br />AObI'- SIJHR" ......
<br />LTR ! TYPE OF INSURANCE NSR' WV POLICY NU BER POLICY EFF - - POLJCY EXP
<br />'
<br />-
<br />-'
<br />GENERAL LIABILYTY
<br />'. IMM1VOO/'1'YWI (MM/COMYYV LIMIT$
<br />_..
<br />�` X
<br />CACH OCCURRENCE
<br />51.000, ODD .
<br />CUMM£F2CIAi. GENERAL LIA9IL YTY - - Cps1377665
<br />'
<br />OS/27 /2°11 p5 /J7 /2012 bAMAGE T'O RCN'fF0
<br />-
<br />_
<br />1DD, DDD
<br />/
<br />CLAIMS -MAL`E X OCCUR )/
<br />PREMISE $.LE rxcurranca)
<br />b
<br />MED EXP_ {AnY crx. Pacu>ry
<br />5 S ,ODD
<br />-
<br />' PER50NALBAOV INJURY
<br />$1, OOO DDD
<br />_ -- '.
<br />'. GENERAL AGGR( (lA TE
<br />52 r 000 000
<br />G£hL A. ^ >(iREGAIF LIMIT /LL >VVES PF.H -
<br />-
<br />,
<br />I
<br />'. ', PRO- '
<br />' F'RODUC.'1'S COMV /OP AGG
<br />$1,000,OOD_
<br />POLICY / \':. T LOC
<br />_ ._._
<br />_...
<br />AUTOMOBILE LIABILITY
<br />�
<br />COMHINEO SINGLE LIMIT
<br />aam.,nt)
<br />-'
<br />$1, 000, 000
<br />'� ANY Al1TU _ _ - Cp$13']']665
<br />SCHEDlJlEO
<br />,..(Fd
<br />OS /27 /2011 DS/27/2012 BODIIX INJl1RY(Per Pr>r;can)
<br />E
<br />A:JT05 AVT05
<br />�� -�� -
<br />NON�00.'NEU
<br />DOUIIV eNJIJHV F'uramldnnt
<br />( )
<br />__.
<br />$
<br />' ! IIR;-D AUTOS
<br />.._ AUTOS
<br />�
<br />PRVPERTV I)AMAGF
<br />I
<br />fPO ac .elan)
<br />$
<br />5
<br />UMBRELLA LIAR OCCUR ': '.
<br />_
<br />'' � '
<br />E %CES$ LIAR -,
<br />� EACH OCCURRENCE
<br />$
<br />�_._. CLAIMS MADE
<br />:...
<br />DEiJ RETENTION $
<br />_
<br />'. WORKERS COMPEH SATON - "'
<br />�
<br />-'" _
<br />$
<br />ANO EMPLOYERS' LIABILITY
<br />._._
<br />- WC S TArU - _ OTH
<br />_
<br />-
<br />' ANY PROPR:ETiJR/PnRTNE R/E- XE ^,Li LIVE Y/N
<br />$
<br />', TORY. LIMITS _ ER _.
<br />OFpIC. ^R1M£MBER E %GW:JEf» � -N /A'. .19624 rje
<br />06/OG/2U11 D5 /OC /2012 El EACH ACCIDENT
<br />$1,000,000.
<br />(Mandatory le NHI ��
<br />- ...
<br />_
<br />'I'ybs descnbe unUar ' '
<br />EL DISEASE FA EMVI -UYEE
<br />$1, DOD, 000.
<br />DESCRIPTION OF OPERAI'IC)N5 be'�ow
<br />E:.I_ DISEASP - POLICY LIMIT �
<br />$=_.i OOD , 00 D .
<br />OESCRIPTON OF OPERATON$ f LOCATIONS I VEHICLES (Alta cb ACO R° tb1, Additional Ramarlts ScN ad ula, Ir mere s ca fa ragylrotl>> '�
<br />30 day notice of cancellation except on -pay, than 10 days appf ies_ Hlanket additional insured #CG20330704
<br />primary /non - contributory workding #GLS29s (D7 /OH) waiver of subrogation #CG24041093 along with per project
<br />aggr @gate #CG2503 3 -97 included as part of general liability policy -
<br />The City of Santa Ana> its officers, employees, agents, vo lun toers and rep re san to fives era additional
<br />insured par company forms listed above and city's form, attach ®d.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOVED ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ff//yy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />f �,
<br />City of Santa Ana � � � —��`K �/� ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Pub lie wot -)cH Ags:' °y Laur ttC Shccdy
<br />220 S .. Daisy Ave. M -BS � AUTHORIZE° REPRESE ATIVE /
<br />Banta Ana, cA 927oz �'- »Ester C.i(y ALtorne�/ �,� �,.- / /�� J
<br />Jv"' - - -_ � '-
<br />�© 1988 -2010 ACORD CORPORATION. All rights reserved_
<br />A rill � rl 1
<br />- .- -' - - -. . L� "ra��rcv name anD logo are registered marks of ACORD
<br />. rrr�ocetl �s ny F'on =y� R<a »s Plus snflwnre. www.FCrmsRCas.am>. ImPreasive Pubasning SGO- ?OH -:9 %�
<br />
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