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PADIL -1 OP ID• CH <br />'`'��.,,��"� CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM /DD /YYYY) <br />11 /23/11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />f:ERTIFICATE 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 Ileu of such endorsements . <br />PRODUCER <br />Fullerton Insurance Service 714- 577 -5800 <br />CDI #0596796 714��{7 -0011 <br />'1009 S. Placentia Avenue <br />Fullerton, CA 92831 <br />CONTACT <br />NAME: Leslie McCarth <br />_ _ <br />q/C NNO E :l:714- 577 -5800 FAx <br />(A/c. Ne): 71447 -0011 <br />E -MAIL <br />ADDRESS: reC fullertoninsurance . com <br />INSURERS AFFORDING COVERAGE <br />NAIC M <br />Leslie A. McCarthy <br />INSURERA:TraVCler$ Indemnl Co of CT <br />25682 <br />_ <br />INSURED Padilla 8[ Associates, InC. <br />211 East Clty Plac@ Dr. <br />Santa Ana, CA 92705 <br />INSURER B :AXIS Surplus Insurance Co. <br />26620 <br />INSURER G <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE �X OCCUR <br />-- _ <br />INSURER D <br />_ <br />6805986L954 -11 <br />INSURER E <br />08/'17/12 <br />DA ASE TO REN7Eb <br />PREMISES Ea occurrence <br />INSURER F <br />MED EXP (Any one person) <br />__ <br />$ S,OO <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 />ILTR <br />TYPE OF INSURANCE <br />D <br />POLICY NUMBER <br />MM/LDD /YYYY <br />MM /DD /YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE �X OCCUR <br />X <br />6805986L954 -11 <br />08/17/11 <br />08/'17/12 <br />DA ASE TO REN7Eb <br />PREMISES Ea occurrence <br />$ 300.00 <br />MED EXP (Any one person) <br />__ <br />$ S,OO <br />8 ADV INJURY <br />$ 2,000,00 <br />— —.. _.._. _ <br />_PERSONAL <br />GENERAL AGGREGATE <br />$ 4,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO LOC <br />PRODUCTS - COMP /OP AGG <br />$ 4,000,00 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />INCLUDE <br />BODILY INJURY (Per person) <br />$ <br />A <br />ANY AUTO <br />6805986L954 -11 <br />08/17/11 <br />06/17/12 <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />NON -OWNED <br />HIRED AUTOS X AUTOS <br />X <br />PROPERTY DAMAGE <br />Per accitlen[ <br />$ <br />$ __ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />.4NY PROPRIETOR /PARTNER /EXECUTIVE ; l <br />OFFICER /MEMBER EXCLUDED? U <br />N / A <br />WC STATU- OTH- <br />Y I <br />EL_ EAGH ACGfUEN I" <br />_ <br />$ <br />EL DISEASE - EA EMPLOYEE <br />$ <br />(Manda[ory In NH) <br />If yes, describe under <br />EL DISEASE - POLICY LIMIT <br />__ <br />$ <br />DESCRIPTION OF OPERATIONS below <br />B <br />Professional Liab <br />ENN592110 <br />11/15/11 <br />11/15/12 <br />Agg /Occ 1,00D,00 <br />Ded z,so <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (A!lach ACORD '101, Addlllonal Remarks Scbedule, I! more space Is rsqulred) <br />Certificate holder is named as additional insured as required by written <br />contract per the attached form #CGD248(OS/05).30 Days notice of '! 1' �':�..(.��ll} -�� j'�;,j i� %) f-i.: <br />cancellation except 10 days for non - payment of premium. Re: Proeject One i�� .• . <br />Catalina Street Pump Owners Association Water Services Connections. Project <br />Two: Diamond Park Mutual Water Company main Improvements <br />ly <br />l.ArvI.CLLA 1 1 VIV <br />CTYSANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Ci of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Brian Ige <br />220 S. Daisy Ave., M -85 AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92703 � _ <br />©1988 -2010 AC ORD CORPORATION_ All rio hts reserved_ <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />