|
WEMI
<br />,acoRO CERTIFICATE OF LIABILITY INSURANCE
<br />`••�-��
<br />DAT6/412 DlYYYY)
<br />F6/4/2012
<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 />IITIVE ORP OTE OFER, NSUANDRAN CE� �T I� .ITUFf CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />BELOW. THIS
<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 NIT," may require it ,ero+c *ent. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). - / - r1IIeONTAC
<br />PRODUCER (886)8255-4322_ {
<br />i,
<br />Bowermaster & Associates
<br />P.O. BOX 6026
<br />10805 Holder Street - Suite 350
<br />Cypress, CA 90630
<br />NAME: T
<br />acc°NN Ext): 1 -714-733-6251 A/c, No): 1-714-252-8253
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER
<br />CUSTOMER ID#:HONCOM-001
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED Hondo Company, Inc.
<br />2121 South Lyon Street
<br />Santa Ana, CA 92705-
<br />INSURER A: Landmark American Insurance Co.
<br />INSURERB:Travelers Indemnity Company
<br />INSURERC:RSUI Indemnity Company_
<br />INSURER D:Preserver Insurance Company
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION 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 WHICH THIS
<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 />ADDL
<br />TYPE OF INSURANCE IN R
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY X
<br />CLAIMS -MADE OCCUR
<br />LHA136125
<br />6/1/2012
<br />6/1/2013
<br />1DAMA E T REN D
<br />PREMISES Ea occurrence $ 50,00
<br />MED EXP (Any one person) $ 5,00
<br />PERSONAL &ADV INJURY $ 1,000,00
<br />X BIlPD Ded./OCC $5,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />POLICYFX PE OT- LOC
<br />$
<br />B
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />BA2A092685
<br />6/1/2012
<br />6/1/2013
<br />COMBINED SINGLE LIMIT $ 1,000,00
<br />(Ea accident)
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />(Per accident)
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCURi
<br />- - }y` t. l ,
<br />EACH OCCURRENCE $ 2,000,00
<br />AGGREGATE $ 2,000,00
<br />C
<br />X EXCESS LIAB
<br />CLAIMS -MADE
<br />NHA230581
<br />6/1/2012
<br />6/1/2013
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />D
<br />WORKERS COMPENSATIONWC
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?FY7
<br />(Mandatory in NH)
<br />NIA
<br />WCCO017519
<br />1/1/2012
<br />1/1/2013
<br />STATU- OTH-
<br />X TORY LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are
<br />named as additional insureds with respects to General Liability per form RSG15017 1207; Primary wording is included.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD I
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />C/O Public Works Agency- The Depot
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M-21
<br />AUTHORIZED REPRESENTATIVE
<br />C
<br />Santa Ana, CA 92701-
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD I
<br />
|