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A►coirc� CERTIFICATE OF LIABILITY INSURANCE
<br />00/30/2DO
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS-4
<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.I
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, t I.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. R SUBROGATION IS WAIVED, subject to-F
<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 />ONTACT
<br />NAME:
<br />Hay, of California Insurance services - Ontario
<br />pNaNE ,909.243-8200909-243-8201
<br />NC No
<br />ApORE
<br />4200 Concours, Suite 350
<br />RDD ER
<br />Ontario, CA 91764
<br />INSURERS AFFORDING COVERAGE NAICN
<br />Kirk Nivilerts
<br />INSURED
<br />INSURERA: Associated Industries Insurance company
<br />American Wrecking, Inc
<br />INSURER 9: Liberty Mutual Insurance Corp,
<br />INSURER C: RSDI IND CO 22314
<br />2459 LOA Avenue
<br />INSURER O: STATE CONPSNSATION INSURANCS POND
<br />South E1 Monte, CA 91733
<br />INSURER a:
<br />D,q
<br />G G V
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 41669589 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 THMI.-
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 7ERMST;
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. '� 1
<br />MIST
<br />p
<br />TYPE OPINeURANCE
<br />POLICY EFF POLICY EXP
<br />POUCYNUMBER MWDD MMM[
<br />LIMITS - "
<br />A
<br />GENERAL LMBIUTY
<br />ARSID27276
<br />08/05/1
<br />08/05/15
<br />EACH OCCURRENCE S 1,000,000
<br />PREMISESEe ocournonoel $ 50,000
<br />8 COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE L_�J OCCUR
<br />MED EXP NY one person) $ 51000
<br />PERSONAL aADV INJURY $ 1,000,000
<br />GENERALAGGREGATE $ 2,000,000
<br />OENI AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS-COMPIOP AGG r 2,000,000
<br />POLICY
<br />8 PFICT RO- LOC
<br />$
<br />H
<br />AUTOMOBILELIABILRY
<br />K
<br />ANY AUTO
<br />ASJ291457618.014
<br />09/01/1
<br />09/01/15
<br />COMBINED SINGLE LIMIT $ 11000,000
<br />(Ee ecdtleni)
<br />BODILY INJURY(Pw person) r
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Par aWdom) $
<br />SCHEDULEDAUTOG
<br />HIRED AUTOS
<br />PROPERTY DAMAGE
<br />(Par soodenl) $
<br />$
<br />NON-OWNED AUTOS
<br />CdUMBRELLA
<br />LLAB
<br />8
<br />OCCUR
<br />NU236094
<br />08/05/1
<br />08/05/15
<br />EACHOCCURRENCE $ 10,000,000 '.
<br />AGGREGATE S 10,000,000'17
<br />A
<br />EXCESS LUV!
<br />CLAfft - AOE
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABI JTY - YIN
<br />ANY PROPMETORYPARTNERIDECUTNE
<br />OFFICERMEMBER EXCLUOEO9 FLIMIA
<br />(Mandatory In NM)
<br />9113676-14
<br />10/01/1
<br />10/O1/15
<br />X WC STATU- OTK
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE-EA EMPLOYEE $ 1,000,000
<br />II yea deapafa Under
<br />OE SCRIPTION OF OPERATIONS tebe,
<br />E.L. DISEASE. POLICY LIMIT $1,000,000
<br />60M
<br />Dee CRI ON OF OPARAUONS I LOCATIONS IVEHICLES J'Attowh 101, Additional Renarlu Schedule, monspaamragalred)
<br />City of Santa Atte, its officers, employees, agents, volunteers and representatives are named ea
<br />additional insured as reapette t0 general liability. Primary and Don-contributory wording also applies, as, respects to
<br />general liability per endorsement attached.
<br />SD days aotioe of cancellation. �eJrgh �hgi-gary M36 —page
<br />CERTIFICATE HOLDER CANCELLATION
<br />oJoaef C 1908.2009 ACORD CORPORATION, All rights reserded., �
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD -
<br />41669589
<br />SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE,
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN....
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />-..�+"
<br />DBA
<br />oJoaef C 1908.2009 ACORD CORPORATION, All rights reserded., �
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD -
<br />41669589
<br />
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