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LVI
<br />O )
<br />12/21
<br />,acQRI� CERTIFICATE OF LIABILITY INSURANCE D /DD/YYYY
<br />12/2112011
<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). v'
<br />PRODUCER (888) 825-4322
<br />Bowermaster & Associates
<br />P.O. BOX 6026
<br />10805 Holder Street - Suite 350
<br />Cypress, CA 90630
<br />NAMEACT
<br />PHONE FAX —
<br />C No Ext): _ (A/C, No
<br />E-MAIL ,
<br />ADDRESS: _ ----- -
<br />PRODUCER HONDCOM-01
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE NAIC # .
<br />INSURER A: Landmark American Insurance C6.._
<br />INSURED Hondo Company, Inc.
<br />INSURER B: Travelers Indemnity Company
<br />2121 South Lyon Street
<br />Santa Ana, CA 92705-
<br />INSURER C: RSUI Indemnity Company
<br />INSURER D: Preserver Insurance Company Iji _
<br />''y /�-�
<br />pA [ (/ _t2®n`
<br />INSURER E:
<br />INSURER F
<br />CERTIFICATE NUMBER• REViSiON NUMBER:
<br />COVERAGES
<br />CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />THIS IS TO
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />INDICATED.
<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 />UBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EAC HOCCURRENCE $ 1,000,00
<br />PREMISES Ea occurrence $ 50,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />X
<br />',LHA135408
<br />61112011
<br />6/1/2012
<br />MED EXP (Any one person) $ 5,00
<br />CLAIMS -MADE 41 OCCUR
<br />PERSONAL & ADV INJURY $ 1,000,00
<br />X BI/PD Ded./OCC $5,000
<br />GENERAL AGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />$
<br />PRO-
<br />POLICY X LOC
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,00
<br />(Ea accident)
<br />B
<br />X
<br />ANY AUTO
<br />BA2A092685
<br />6/1/2011
<br />6/1/2012
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />SCHEDULED AUTOS
<br />-
<br />PROPERTY DAMAGE $
<br />HIRED AUTOS
<br />! ,, _
<br />(Per accident)
<br />NON -OWNED AUTOS
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 2,000,00
<br />AGGREGATE $ 2,000,00
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />NHA228267
<br />6/1/2011
<br />6/1!2012
<br />—
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />WORKERS COMPENSATION
<br />X I WC STATU- OTH-
<br />TORY LIMITS ER
<br />D
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEY�
<br />'WCCO01751 901
<br />1/1/2012
<br />1/1/2013
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00
<br />0 CER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, agents and employees are Additional Insureds in regards to General Liability per the attached RSG 15017
<br />1207 endorsement. Primary wording is included.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Purchasing Dept
<br />20 Civic Center Plaza - Ross Annex
<br />Santa Ana, CA 92701-4010 AUTHORIZED REPRESENTATIVE
<br />© 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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