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Policy Number: A0109 -72 -22 Data Entered: 11/18/2013 AeoR®® CERTIFICATE OF LIABILITY INSURANCE Ill DATE(MMIDDIYYYY) 11/18/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brad Hume Insurance Agency 23231 South Pointe Dr #101 Laguna Hills, Ca 92653 CONTACT NAME: FAX (949)830 -7970 ,vc Net: (949)830 -9746 EMAIL ADDRESS: ,� S A °`'� yy f o *o ' q ()J INSURERS AFFORDING COVERAGE NAIC p INSURER A: TRUCK INSURANCE EXCHANGE $ MED EXP(Any one person) INSURED THE PETERSON GROUP, INC. INSURER B: $ INSURER C AGGREGATE INSURER D: GEN'L AGGREGATE LIMIT APPLIES POLICY SECT_ 18851 BARDEEN AVE #225 INSURER E: $ IRVINE, CA 92612 dl ..D �70 j�.op^ �•V •1 •Y INBURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADbL INSR SUBS WVD POLICY NUMBER POLICY EFF MMIDWYYVV POLICY EXP MMIDDNYYV LIMITS ATTN: GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-IOCCUR P.O. ,� S A °`'� yy f o *o ' q ()J EACH OCCURRENCE $ PREMISES Eacccurrence $ MED EXP(Any one person) $ PERSONAL B ADV INJURY $ AGGREGATE GEN'L AGGREGATE LIMIT APPLIES POLICY SECT_ PER: LOG PRODUCTS COMWOP AGO $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NONOSOWNED \ .. .wT v�ilpTa. "� y1Sl.atlt. ,,SJ t�CU11CC L]S /a,CL09 (;11.Y ,,,, „,.. t ?C' '° COMBINED SINGLE LIMIT Eaacciden[ BODILY INJURY (Per person) $ BODILY INJURY (Per accldenQ $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ BED RETENTION $ IS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDEOP (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A0109 -72 -22 04/11/2013 9/11/2019 WC STATU- OTH- TORY LIMITS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE EA EMPLOYEE $1,000,000 E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.cotm Impressive Publishing 809- 208 -1977 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA PUBLIC WORKS AGENCY ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: CHRISTY KINDIG, PROJECTS MANAGER P.O. BOX 1988, M -21 AUTHORIZED REPRESENTATIVE SANTA ANA, CA 92702 ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.cotm Impressive Publishing 809- 208 -1977