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,acoRo° CERTIFICATE OF LIABILIT
<br />A ICE[---�ATE(MM!°°"""'
<br />10/31/2012 9/28/2012
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R164YS dPdN Tfif-ICEIIIIfigtikE 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 CONTRAaI/WEEN 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(les) must herr rsed. If SUB#i0� ¢A�61�7 IS'WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this c.=,eat not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER Lockton Comparies, LLC Denver
<br />8110 E. Union Avenue
<br />Suite 70C
<br />Denver CO 80237
<br />(303) 414-6000
<br />NA
<br />FRONIANC. E ExtL: IA , Na
<br />E-MnN
<br />FILE s s:
<br />INSUR RI 1 AFFORDING COVERA E NAIL'
<br />INSURER A: Stan'" indemnity & Liability Comganv 38318
<br />INSURED Pacific Building Care, Inc.
<br />1345173 dba Commercial Cleaning Sstems
<br />1375 Sunflower Avenue, #200
<br />Costa Mesa, CA 92626
<br />1 �I`
<br />INSURER 13:, T)ennciinrg In.-iirance C'mmnanv 425,97
<br />NgQRFR c; St Paul Surplus Lines insurance Comnanv 30491
<br />Trz,aers Cy uaq m,d Sony Co ofA—n-
<br />INcnwFP n • 31 194
<br />Iucnoao F .
<br />INSURER F
<br />COVERAGES P13C',11000 ts7231ERTIFICATE NUMBER- 12()00961 REVISION NUMBER- XXXXXXX
<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 />INR
<br />W
<br />TYPE OF INSURANCE
<br />ADDL
<br />I $
<br />SU13R
<br />POLICY NUMBER
<br />POLICY EFF
<br />f y
<br />POLICY EXP
<br />imMlnnrvvvyI
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />Y
<br />N
<br />SISIOCS06001 2 2 '.
<br />10/1/2012
<br />10/1/2013
<br />EACH OCCURRENCE G 900.000
<br />oAMAG- TC H NTED
<br />P' rF G e 0
<br />XEk.ICFG
<br />COMMERCIAL sGENE�RAL� LIABILITY
<br />ACORD 25 (2010/05) ©19 0'10 ACORD CORPOKATION. All rights reserved
<br />CLAIMS -MADE : "- I OCCUR
<br />MED EXP Ory one parson/ Q
<br />PERSONAL & ADV INJURY $ 900,000
<br />X a =
<br />GENERAL AGGREGATE S 1.900.000
<br />GEN'I_ AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS. COMPICIP A ,G $ 17966.656
<br />PRO- LO -
<br />X P LI =!E-71
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />N
<br />N
<br />ACP7505806934
<br />10/1:21.112
<br />10/1/2013
<br />rCtOMOOINEDSINO: I—LIMI? S 1.000,000
<br />BODILY INJURY (Per person) $ XXXXXXX
<br />X
<br />ANY AUTO
<br />AUTOS�NEDqS11HEDIILEDTOBODILY
<br />INJURY (Per accident $ XXXXXX".X
<br />N,C;�f OWNED
<br />HIRED AUTOSAUTOS
<br />PROPERTYtDAMAGE$ ;YXXkXXX
<br />ase! 9--d'len.
<br />$ XXXXXXX.
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />1N
<br />N
<br />QZ08300059
<br />10/31/2011
<br />10/311,12012
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $ 5.,900,,9,9,9
<br />EXCESS LIAB
<br />CLAWS -MADE
<br />DED X RETENTION $O
<br />_ $ XXXXXXX
<br />A
<br />WORiCEFtSCOMPENSATION
<br />AND EMPLOYERS' LIABILITY y, I N
<br />AN GFFICER MENSERIEY.CLUDEE-, TIVE �
<br />(Mandatoryin NH)
<br />It yes, des_b Inde:
<br />OESCRIPTiON OF
<br />N 1 A
<br />N
<br />10000010$4
<br />10/I /2012
<br />10/1/2013
<br />W STAT��77- O?N-
<br />X. "i OY I,IMIrS FA
<br />E.L EACH ACCIDEPIT $ 1 ,Q0Q_Q0Q
<br />R..L DISEASE - EA EMPLOYEE $ 1.000.000
<br />E-!� <Fptc. POLICY I 00.000
<br />D
<br />P:mpk,yze'Illef: :nd105738933
<br />timploy. "!heft of Client
<br />N
<br />�'
<br />10/1/2012
<br />5/1/2013
<br />51,000,000 Lirnn
<br />S25,000 Deductible
<br />Prop
<br />DESCRIPTION OF OPERATIONS; LOCATIONS I VEHICLES !(Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />** Refer to Attached.*
<br />t V
<br />4QMJI "I -J. rl%JLwmr[
<br />lrH1Yl.CLLHIIURc\!i ..-:'..Y7-UY T
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />12000961
<br />AUTHORIZED REPRESENTATIVE
<br />City of Santa Ana
<br />c/o Public Works Agency/SARTC
<br />20 Civic Center Plaza, M-21
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010/05) ©19 0'10 ACORD CORPOKATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
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