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<br />t?o?® <br />CERTIFICATE OF LIABILITY INSURANCE <br />41 DATE(MMIDDYYYY) <br /> <br />03/20/2013 <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 CEI?p'? FICAT9 HO,IIR.. <br />IMPORTANT: If the certificate holder r an ADOI 1ONAL,INSURED, Ihe!rO )PS) 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 t"-- - <br />PRODUCER * CNaNTCT <br />E <br />Theo Insurance Services, Inc. 213 380-4040 FNot. 213 380-4020 <br />3540 Wilshire Blvd., Suite 1210 E-MAIL <br />sarah.lee@theoins.com <br />ADDRESS- <br />Los Angeles CA 90010 INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A: State Compensation Insurance Fund <br />INSURED SURER B: <br />RB Welding, Inc. 7 (K^/ INSURER C: <br />155 E Redondo Beach INSURER D <br />Gardena CA 90248 INSURER E, <br /> INSURER F <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 />NBR ADDL SUBR POLICY EFF POLICY EXP <br /> <br />LTR TYPE OF INSURANCE POLICY NUMBER LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE <br /> DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY PREMIRES (Ea.o <br /> <br /> CLAIMS-MADE ? OCCUR MED EXP An one person) <br /> PERSONAL &ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO <br /> POLICY PRO- LOC <br />Irr.T _] $ <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALLOWNED SCHEDULED <br />BODILY INJURY (Per accident) <br />$ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS <br />AUTOS $ <br /> <br /> <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LAS CLAIMS-MADE AGGREGATE <br /> DEO RETENTION <br /> WORKERS COMPENSATION <br />AND EM <br />LOYE <br />S' LIABILITY X TWO STATU- OTH- <br />FIR <br /> P <br />R <br />Y/N <br /> ECUTI <br />PROPRIETORTARTNERJE <br />ANY <br />V?? I EL EACH ACCIDENT $1,000,000 <br />A O <br />FFICER/MEMBER EXC UDED? <br />I <br />(Mandatory in NH) N <br />IA 013369-11 01/01/2013 01/0112014 E. L. DISEASE-EA EMPLOYE $1,000,000 <br /> faYs describe under <br />DESCRIPTION OF OPERATIONS below J <br />E.L. DISEASE-POLICY LIMIT <br />$1,000,000 <br /> APP. VE AS TO NORM <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VE ' ORD 101, Additional Remarks Schedule, if more space is required) <br />Laura Stitt Sheedy <br />Assistant City Attorney <br />-cancellation clause reverts to 10 days for non payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, M-21 <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE ? <MK> <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br /> <br />