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-A - ao(^ - r C4 - o y <br />CERTIFICATE OF LIABILITY INSURANCE OP ID ITT <br />M/DDM'W) <br />02(MX15/12 <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 />REPRESENTATIVEOR PRODUCER, AND THE CERTIFICATE HOLDER. <br />t e cert cafe holder I INSURED. the po cy es must a en orse . , su Oct 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 endorsement(s). <br />PRODUCER <br />NAME: <br />(A/c, No, E't): (AIc. No): <br />Roger Stone Insurance Agency <br />ADDRESS: <br />5015 Birch Street <br />Newport Beach CA 92660 <br />CVSTOMER IDs PACI-12 <br />Phone:949-757-0270 L'ax:949-757-0375 <br />INSURER(S) AFFORDING COVERAGE NAICi <br />INSURED <br />INSURER A: SCOttsdale Ins. Co. 43.297 <br />PaCi£iC S Stems EleCtriC XnC. <br />3j670 Dowling Court <br />INSURER B: Mercu Casualty Co 1190$ <br />INSURER C: <br />Wnchester CA 92596 <br />INSURER D <br />02/02/13 <br />INSURER E <br />MED EXP (Any one person) $S'000 <br />INSURER F <br />--vcrlMb CJ I =m I IriGA I C KUMlSC K: REVISION N[IMRFR- <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 />LTR <br />TYPE OF INSURANCE <br />INSR <br />POLICY NUMBER <br />(MM/DD/YYYY) <br />(MWDD/YYYY) <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $3.,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE O OCCUR <br />CPS 1523735 <br />02/02/12 <br />02/02/13 <br />PREMISES (Ea occurrence) $ 100 , 000 <br />MED EXP (Any one person) $S'000 <br />PERSONAL & ADV INJURY $ 3_000,000 <br />x <br />GENERAL AGGREGATE s2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />POLICY FX PRO- <br />JECT LOC <br />Emp Ben . $ None <br />3 <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />CCA0006663 <br />02/01/12 <br />02/01/13 <br />COMBINED SINGLE LIMIT <br />(Ee accident) $ 1,000,000 <br />BODILY INJURY (Par person) $ <br />ALL OWNED AUTOS <br />BODILY INJURY (Par accitler ) $ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />PROPERTY DAMAGE <br />(Per accitlarri) $ <br />NON -OWNED AUTOS <br />$ <br />$ <br />A <br />UMBRELLA LIAB <br />OCCUR <br />XBS0020085 <br />02/02/12 <br />02/02/13 <br />EACH OCCURRENCE $4,00 ,000 <br />X <br />E%CESS LIMB <br />CLAIMS -MADE <br />AGGREGATE $ 4,000,000_ <br />DEDUCTIBLE <br />X <br />RETENTION $ N/A <br />$ <br />AND EMPLOYERS' LIABILITY YIN <br />ANVPROPRIETOWPARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />IA <br />TORY LI ER4 <br />E. L. EACH ACYENT� $ <br />ICR <br />_ <br />E.L. DISEASE-- EA EMPLOYEE 4 <br />(MandMo y In NH) <br />II yes,be <br />DESCRIPTION OFF OPERATIONS below <br />E.L. DISEASE.- POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Atldltlonel Remerkc Schedule, n more sped b requir,d) <br />RE: Electrical services for the City o£ Santa Ana CA <br />The City of Santa Ana its officers, emp toyees agents and representatives.` �O <br />are named Additional Ensured per form CG2Qi00764 attached. insurance is - -- <br />}primary and non-ntributop <br />ry er ;form GLattacd <br />10 day notico GLS -295s (7-08) he. <br />c --,e of cancellation for non-payment of premium. <br />a.rrva.cLLr I wry <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CITYSA9 THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br />City o£ Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. %XXX]:XXX:CXXX <br />Attn: Building Dfaintezyay(,e-.p. � 'TO F <br />20 C1V1C Center Drive kl A IZED REPRESENTATIVE <br />P.O. Box 1988 / <br />Santa Ana CA 92702 i��Liy <br />I_.-�® 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The AGChRD:nani(:an¢ IdgD@te"pistered marks of ACORD <br />