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4
<br />OP ID: KG
<br />A41t7eORtY
<br />CERTIFICATE 4F LIABILITY INSURANCE
<br />DATE (MMlDDfYYYY)
<br />08104/1/
<br />THIS CERTIFICATE 1S 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).
<br />PRODUCER 909-886-N61
<br />Alliant Insurance Services,lnc
<br />(Lic-0C36861) 909-886-2013
<br />735 Carnegie Drive, Ste 200
<br />San Bernardino, CA 92408
<br />5057.Jay Freeman
<br />CONTACT
<br />NAME
<br />pHp FAX
<br />No):
<br />E-MAIL
<br />ODUCER
<br />PRODUCER
<br />MACAD-1
<br />INSURE S AFFORDING COVERAGE
<br />NAICfF
<br />INSURED Macadee Electrical Inc
<br />4755 Lanier Road
<br />Chino, CA91710
<br />INSURER A:Travelers Property Casualty
<br />25674
<br />INSURER B:Travelers Indemnity Company
<br />NsuRERc:Fireman's Fund Ins Co
<br />INSURER D
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: RFVISION 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 WrfH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A.LL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSLTR
<br />TYPE OF INSURANCE
<br />AD0
<br />POLICY NUMBER
<br />MMOPOOP YM EFF
<br />MMPOLICY ExP ym
<br />LIMITS
<br />GENERAL LIA63UTY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />X
<br />DTC00413B657TIL11
<br />02/01/11
<br />02/01/12
<br />PREMISES Ea oocurrence
<br />$ 50,00
<br />MED EXP (Any one person)
<br />$ 5,00
<br />X $5,000 PD Ded.
<br />PERSONAL &ADV INJURY
<br />$ 1,000,006
<br />per occ.
<br />GENERAL AGGREGATE
<br />$ 2,060,00
<br />GEN'LAGGREGATE LIMIT APPLIES PER
<br />PRODUCTS -COMP16PAGG
<br />$ 2,000,00
<br />POLICY X PRO- LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LUIBILTfY
<br />ANY AUTO
<br />BA951 SC49211
<br />02/01/11
<br />02101/12
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />j
<br />800ILY INJURY (Per accident)
<br />S
<br />X
<br />(Per accident)
<br />$
<br />X
<br />$
<br />A
<br />NON-OWNEDAUTOS
<br />UMBRELLAUAB
<br />X
<br />OCCUR
<br />,. - `., .,..
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />HDEDucTIBLE
<br />AGGREGATE
<br />$ 1,000,00
<br />EXCESS LUU3
<br />CLAIMS -MADE
<br />•, I�;
<br />P365K6034T1L11
<br />`D21b2/i1' "-
<br />0 A1/12
<br />$
<br />X
<br />RETENTION $ 10,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILI Y YIN
<br />ANY PROPRIETORIPARTNERIEXECIITNE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />OTEUB5637L65010
<br />08115/10
<br />08/15/11
<br />X I WCSTATLL O7H-
<br />TRY ITER
<br />E.LEACHACGDENT
<br />s 1,000,00
<br />—
<br />E.L.DISEASE - EA EMPLOYE
<br />$ 1,000,00
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L.DISEASE - POLICY LIMIT
<br />$ 1,000,00
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />Rented Leased
<br />MX198306959
<br />02/01/11
<br />02/01/12
<br />Limit 75,00
<br />Dad. 1,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
<br />Job: Oakmont -Fairmont Rewiring Project.
<br />The City of Santa Ana its officers, employees, agents, volunteers and
<br />re
<br />representatives aadditional insured/pnmary and non-contributory as
<br />respects general liability per endorsement CGD46 08-05 attached.
<br />CISANTA
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<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 />AUTHORIZED REPRESENTATIVE
<br />V A .ea��
<br />C 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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