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<br />Client#: 458248
<br />MASTELEC5
<br />5/012012
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />° 5'A1U012
<br />/012o1z
<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 CERTIFICATgI(4LM11. 22 G'A
<br />IMPORTANT: If the cart6kate holder Is an ADDITIONAL INSURED, the policy(les) must a endorsed. H SUBROGATION IS WANED, subject to
<br />the terms end conditions of the policy, Certain policies may Mpire an endorsement. A statement on this Certificate does not Confer rights to the
<br />Certificate holder in lieu of such endorsement(s).
<br />PROD CEt i'_.
<br />Kristie Koehrer
<br />Hub International
<br />HUB International
<br />Serv. Inc.
<br />4371 Latham St, Ste #101
<br />Riverside, CA 92501
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<br />ACNN. m:87 825 -2681 ,tc N„ 951231-2572
<br />s; Ca1.CPU @h ubinternaticna1.com
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<br />Indemnity C pant' f
<br />INSURERA: Travelers Indemnity Company of
<br />82
<br />25882
<br />INSURED
<br />INSURER B: Travelers Property Casualty Cc
<br />25674
<br />TSJ Electrical le Communications, Inc.
<br />INSURER C: Companion Prop and Cos Ins Cc
<br />12157
<br />dba Masters Electric
<br />7490 Jurupa Avenue
<br />Riverside, CA 92504 N O — O ^
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<br />INSURER °:
<br />pEpAApJMC,�Hpp��OE�CCTTURRENCE
<br />PREMISES aua,D,lo
<br />INSURER E:
<br />MED EXP Wy we pawn)
<br />INEURER F:
<br />PERSOW & ADV INJURY
<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 CONTRACTOR 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 />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />y�3ERXCLUSIONS
<br />L7R
<br />TYPE OF INSIIRIINCE
<br />A0O
<br />°B
<br />PgJCY NUMBER
<br />UNITS
<br />A
<br />X
<br />4T22CO9011PO41TCT1
<br />20/2012
<br />04120201
<br />$1000000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FRI OCCUR
<br />pEpAApJMC,�Hpp��OE�CCTTURRENCE
<br />PREMISES aua,D,lo
<br />f300006
<br />MED EXP Wy we pawn)
<br />$5,000
<br />PERSOW & ADV INJURY
<br />$1000000
<br />X PDDed: $2,500
<br />GENERAL AGGREGATE
<br />s2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />PROOUCTS- COMFIMP AGO
<br />(2,000,000
<br />POLICY PRO LOC
<br />f
<br />A
<br />AUTOMOBILEUASUrY
<br />BA61398218312CN5
<br />20(2012
<br />0420201
<br />1,000,000
<br />X
<br />BODILY INJURY For
<br />f
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AlfT03
<br />BODILY INJURY PW s iinl)
<br />f
<br />X
<br />�p.°r g�yp&nl °�
<br />S
<br />HIRED AUTOS X NpIOjTNOSEO
<br />S
<br />B
<br />X
<br />usaseuILAM
<br />X
<br />OCCUR
<br />DTSMCUP9011PO41TIL
<br />D4120120112
<br />04/2012013
<br />EACH OCCURRENCE
<br />:5000000
<br />AGGREGATE
<br />$5.000.000
<br />EXCESS UAB
<br />I CLAIMS -MADE
<br />DIED I X1 RETENTION $10,000
<br />S
<br />C
<br />WORKERS OONPB19A7gN
<br />AW EMPLOYERS' LIABILITY YIN
<br />ANY CED EMBERFXCLUOEED ecurnn�
<br />NrA
<br />CPCA74114
<br />?I3PRi�VIill AS `IO
<br />1011812DIl
<br />FORM
<br />10/118120112
<br />% WC SrATU- o TH-
<br />I FR
<br />E.L.EncHnccloENr
<br />(1000000
<br />E . DISEASE - EA EL OYEE
<br />$11,111M.000
<br />(Mrnddvy In NH)
<br />Ir d.saI .Mv
<br />DESCRIPTION OF OPERATIONS Eeim
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />` Laura SL:LL hee
<br />A�,i,IanT City Altoi
<br />net'
<br />DESCRIPTION OF OPERATIONS I LOCATIONS rvEHM:LES (AIUeN ACORD 101, AddMNxW Runk$ Stl,WuY, s mm spso Is rpuFSd)
<br />The City of Santa Ana, Its officers, employees, agents, volunteers and representatives are Additional
<br />Insured In regards to the General Liability policy per attached endorsement form CG D246 08 05,
<br />Primary/Non -Contributory wording Included. Separation of Insureds applies per Standard ISO CG0001 10/01.
<br />Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc.,
<br />Independent of any rights which may be afforded within the policies to the Certificate Holder named below,
<br />(See Attached Descriptions)
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010105) 1 of 2
<br />#51659547/M1650064
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />REPRESENTATIVE
<br />C 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />KC499
<br />
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