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�► �� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDMYY)
<br />12/10/2013
<br />12/10/2013
<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 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 1-909-243-8200
<br />CONTACT
<br />NAME:
<br />Hays of California Insurance Services - Ontario
<br />PHONE,. Ex, 909-243-8200 q Na; 909-243-5201
<br />E-MAAD RIESS:
<br />Empire Towers IV
<br />PRODUCER
<br />3800 Contours, Suite 3400
<br />Ontario, CA 91764
<br />CUSTOMER ID
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />Kirk A. A uilera
<br />INSURED
<br />INSURER A: Associated Industries Insurance Company
<br />MED EXP (Any one person) $ 5,000
<br />American Wrecking, Inc
<br />INSURER B: Liberty Mutual Insurance Corp.
<br />INSURERC: Starr Indemnity & Liability Company
<br />2459 Lee Avenue
<br />INSURER D: California Insurance Company
<br />South E1 Monte, CA 91733
<br />GENERAL AGGREGATE $ 2,000,000
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 37248721 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL SUBR POLICY NUMBER MMIPOLICY EFF POLICY EXP
<br />DYYYY MMIDD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />} Ci,D/ C-itY L$,ttorDCY
<br />AES1027276
<br />08/05/1
<br />08/05/14
<br />EACH OCCURRENCE $ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 171 OCCUR
<br />DAMAGE TO RE TED 50,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGO $ 2,000,000
<br />POLICY X PRO LOC
<br />$
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ASJZ91457618-013
<br />09/01/1
<br />09/01/14
<br />COMBINED SINGLE LIMIT $ 11000,000
<br />(Ea accldenl)
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Par accident) $
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accldenl) $
<br />$
<br />NON -OWNED AUTOS
<br />C
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />1000020279
<br />08/05/1
<br />08/05/14
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE $ 10, 000, 000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNRIEXECUTIVE y
<br />OFFICERIMEMBER EXCLUDED7
<br />(Mandatory in NH)
<br />NIA
<br />73-844023-01-03
<br />10/01/1
<br />10/01/14
<br />X WC STATU- OTH-
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS We.
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />A13 -318J - Grand Avenue Wedining - Demolition at 1222 E. Fourth Street, Santa Ana, CA 92701
<br />City of Santa Ana is additional insured as respects General Liability only. Policy is primary
<br />and non contributory.
<br />30 day cancellation except 10 days for non payment of premium.
<br />CERTIFICATE HOLDER 1 =' 1,:=P. e1i:., CANCELLATION
<br />�"
<br />IT)IT)�.�a
<br />City of Santa Ana .}''
<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 />20 Civic Center Plaza, M-36 Llt`�t �tltt +Sj CC(j
<br />AUTHORIZED REPRESENTATIVE
<br />} Ci,D/ C-itY L$,ttorDCY
<br />Santa Ana, CA 92703
<br />USA
<br />Kirk Aguilera
<br />cjosef © 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
<br />37248721
<br />
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