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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />BA"Imust rr"rl <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE GERTIFI -:ATE HpLDBR. TFI)B <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIRR <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHDRIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(los) must be endorsed. If SUBROGATION 18 WA-W—Kip, egbjecl 19 <br />the terms and conditions of the policy, certain policies may require an andorsement. A statement on this eortilleato does not confer rlghm to the <br />certificate holder In Ilou of such endorsoment(s). <br />PRODUCER , 213. 380.4040 213- 380 -4020 <br />Theo Insurance Services, Inc. <br />3500 Wilshire Blvd. Ste. 914 <br />Los Angeles, CA 90070 <br />Kyonq Park_ <br />�eH1{D„�im_E.1- 213 - 380 -4040 FAX --- <br />. -21 -38 02 <br />noo�e53: <br />INSURERS AFPOROIHOLOVERAOB <br />HAIG <br />INSURER A' e I Ur C 3ny <br />INSURED <br />RB Welding, Inc. <br />155 E. Redondo Beach Blvd. <br />Gardena, CA 90248 <br />INSVRERBI aelorlan noeny <br />08/2012011 <br />msURF Cj <br />EACHOCCURRENCE <br />I INSURER O: <br />—a�E <br />WSwER E: <br />MEDPj <br />INSURER F: <br />PERSONAL A AM IILIURY <br />:ERTIFICATE 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 V*wH T" <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THI( TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />ILSR <br />OFINSURANCE <br />AWL <br />20 Civic Center Plaza <br />POLICY NUMB" <br />PO E <br />W <br />YTYPe <br />11Mn9 <br />A <br />GENERAL LIABILITY <br />T1VCO.k,Lk'ERC(AL GENERALLIABILITY <br />CLAIMS MACE OCCUR <br />08/2012011 <br />09/2012012 <br />EACHOCCURRENCE <br />e <br />—a�E <br />S 50 ago <br />MEDPj <br />SE IU <br />PERSONAL A AM IILIURY <br />51 <br />00044992 -1 <br />00 Deductible <br />GENERAL AGGREGATE <br />5 2,000 QUO <br />GEWI PGGREOATE <br />LIMR APPLIES <br />PER', <br />PRODUCTS• COMPIOP A(IG <br />52 OO O <br />PODGY <br />PB6 <br />LOG <br />5 <br />B <br />AUTOMOSIUMBILITY <br />OMMINED SINGLE IT <br />BOWLY IWURY (Fer potion) <br />a <br />ANYAUTD <br />H <br />AUTOS LIED AUTO <br />PICCA0002622 <br />3127/2011 <br />3127/2012 <br />80MY INJURY IPer erGam,q <br />a <br />HIflEDAUT03 NO -OMIED <br />PROPERTY E <br />i <br />a <br />I <br />1 <br />1 <br />UMBRELLA MB <br />OCCUR <br />EACHOCCUARENCE <br />AGGREGATE <br />EXCESS MB <br />CUIMS -MADE <br />DED RETENTIONS <br />WOBRERSfAMPENSATON <br />VLC4TA1U- p1H• <br />AND EMPLOYERS'MBILITY <br />All PROPRIETOWPARTNEMEtECTIYE YIN <br />FIG Mantlal�ry In lH; PJfCLUOEDi <br />IT ya! dOeQ.Le.W. <br />DESCRIPTONOFOPERAYIONSb.l, <br />NIA <br />C <br />L + L / %f_0' ( / _.. <br />L <br />,, <br />E.L. EACH ACCIDENT <br />E.L. DISEASE-EA EMPLOYEE <br />i <br />E.L. PSEpSE- PDLICY LILIIT <br />— <br />5 <br />OESCfleTON OF OPERATIONS U LOCATOIISI VEHICLES rgryacA ACORO tat, Atltllllenel Remaha ShcatluN, 11 men !p!u la roqulntl) <br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named ay <br />Additional Insureds. Waiver of subrogation applies. <br />- Cancellation clause reverts to 10 days for non - payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRID90 FODCIES BIT CAN09LLEO PEFORE <br />Attn: Purchasing Department <br />9 P <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVORED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />AUTNORQED REPRESENTATIVE <br />t <br />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD <br />