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OP IA: PC <br />'`;` °��OY CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM /DD /YYW) <br />10/03/11 <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 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 626 - 405 -8031 <br />Chapman 626 -405 -0585 <br />License #0522024 <br />P. O. Box 5455 <br />Pasadena, CA 91 1 1 7 -0455 <br />CONTACT <br />NAME: <br />PHONE FAX <br />A/C No E� A/C No <br />E -MAIL - <br />ADDRESS: <br />PRODUCER gACKT -1 <br />CU TOMER ID #: <br />INSU RER(S) AFFORDING COVERAGE <br />NAIL # <br />__ <br />INSURED BackYo Natives Restoration <br />PO Box 6539 <br />Irvine, CA 92612 -6539 <br />e.��= %� L I �0�� /Y1 � <br />Jj+ VVV �.X t� � C--C� <br />INSURERA:NIAC <br />NIAC <br />INSURERe:Southern Insurance Cowan <br />19216 <br />INSURER C <br />$ 1 .000,000 <br />INSURER D <br />$ 500.00__0 <br />INSURER E <br />$ 20,000 <br />INSURER F <br />$ 1.000,000 <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 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD/YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />X <br />Santa Ana, CA 92702 <br />201121765NPO <br />10/01/11 <br />10/01/12 <br />EACH OCCURRENCE <br />$ 1 .000,000 <br />PREMISES Ea occurrence <br />$ 500.00__0 <br />MED EXP (Any one person) <br />$ 20,000 <br />PERSONAL 8 ADV INJURY <br />$ 1.000,000 <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PROT LOC <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />201 1 21 765NP0 <br />10/01/11 <br />10/01/12 <br />Ea a cdeDt) LNG LE LIMIT <br />$ 1,000,00 <br />BODILY INJURY (Per person) <br />S <br />BODILY INJURY (Per accitlent) <br />$ <br />PROPERTY DAMAGE <br />(Per accitlent) <br />$ <br />X <br />X <br />$ <br />$ —. <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANV PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICER/M EMBER EXCLUDED? � <br />(Mantlatory In NH) <br />If yes, tlescriba under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />WSI004552201 <br />10/26/10 <br />10/28/11 <br />WC STATU- OTH- <br />T RY LIMIT ER <br />E.L. EACH ACCIDENT <br />$ 1,000,00 <br />E.L. DISEASE -EA EMPLOYE <br />$ 1,000,00 <br />EA. L.iDIiS�EASE - POLICY LIMIT <br />$ 1,000,000 <br />!�1�fr �I� U I_, 4_� <br />J � , �� <br />DESCRIPTON OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, AtltlHlonel Remarks Schetlule, H more apace la required) <br />Re: Use of City Premise at 600 E. Memory Lane, Santa Ana, CA 92705. The City - <br />of Santa Ana, Its officers, employees, agents and volunteers are named / <br />additional insured with respect to the operations of the named insured per - -- - _. -`2-e %' L�_._L ,LJG /_�/ <br />the attached CG 2026 endorsement. Such insurance is primary and Leu: ra 51.: �; I."`I� �-- -� - - -� " -'�- <br />non- contributo er the attached endorsement. - ✓ <br />CERTIFICATE HOLDER CANCELLATION <br />CITYSAI <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 />The City of Santa Ana <br />20 Civic Center Plaza <br />AUTH�ORIZsED�REAPRES- ENTATNE <br />� v — <br />Santa Ana, CA 92702 <br />©1988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />