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<br />AC"R D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM'YY)
<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(les) 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 endorsomant(s).
<br />PRODUCER Bolton & COmpan __CONTACT NAME:
<br />3475 E. Foothill Blvd., Suite 100 — —
<br />Pasadena, CA 91107 PRDNE AIC NoExp C261�QQ9 �_ EAX_lac Me ._62&583.292 _
<br />INsuaeo iNsuRERe _Safely Nellonal CasUattySPrp4ratlo.n .._(AXt).
<br />Merchants Building Maintenance LLC
<br />1190 Monterey Pass Road NsuRER D _EedQral nsucanae_ComPany__-_.__ fA +Xv)
<br />Monterey Park CA 91754 INSURERS; _L_IBerylnu
<br />INSURER
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1Basno99 REVISION NUMRFP-
<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,
<br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />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 TYPE Of INSURANCE IADfiCj
<br />T�'P'O�L`IC'V EFF POLICY EXP I �----""---"---- —'--
<br />POLICY NUMBER (MMIDDIYYYYI tMMIDDNYYYYYLi LIMITS
<br />A
<br />I GENERAL LIABILITY I
<br />�4
<br />IYV2Z91460650033 i 3/112013 1 EACH OCCURRENCE s_
<br />�. COMMERCIAL GENERAL LIABILITY j
<br />pAry1A�E TO RENTED
<br />IPREMISES(Eaaccurrenca ,S 300.000
<br />. �
<br />CLAIMS MADE !._✓_1 OCCUR
<br />1111112114
<br />MED EXP(Any one person) is 0
<br />-,LGENERALAGGREGAiE
<br />PERSONAL& ADV INJURY iS 1,000 QQO
<br />..
<br />r
<br />S 2,000,000
<br />GE-TN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG iS 2.000090
<br />-- POLICY I ✓ LOC_—
<br />i PRO-
<br />-
<br />A
<br />Au7omoslLE
<br />uaelLr7Y
<br />'AS2Z91460659023 � 3/1/2013 3/1/2014 eacadel�___ ICUR jS 1 000,000
<br />f
<br />---'{ALL
<br />I ANY AUTO )
<br />__
<br />BODILY INJURY (Per person) S
<br />I
<br />OWNED ISCHEDULEpAUTOS
<br />IAUTOS eODILY INJURY (Por acc tlenplS
<br />NON -OWNED
<br />HIREDAUTOS AUTOS
<br />I I
<br />PpROPERTY AMAGE
<br />, jPar anolden� ILR
<br />I
<br />i
<br />D
<br />�,,I_1 UMBRELLA LIAR ' ppcuR
<br />`J-{
<br />1'I'H7Z91460659043 3/1(2013 311/2014 EACH OCCURRENCE �s 10,OOp,000
<br />---t-E%CESS LIAe I CLAIMS-MAD_EI
<br />AGGREGATE `s i0,000 000
<br />DED RETENTION$Q__
<br />g ._ �__
<br />I
<br />--
<br />�)S
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />SP4048488 Excess WC (CA) 4/24/2013 14/24/2014 t _WD STATU 10TH
<br />y DORY LIMITS ER
<br />E
<br />ANY PROPRIETORIPARTNEwEKECUTiVE viN
<br />OFFICER/MEMBER EXCLUDED' NIA
<br />-PJUB598M601013 (AOS) ( 1/l/2013 j1/112014 `"
<br />ELEACHACCOETr 5 1,ODQ.000
<br />m
<br />{Mandatory, In NH)
<br />E.L.DISEASE, EAEMPLOYEEj_S Q
<br />' If yea, descrroe under
<br />DESCRIPTION OF OPERATION' below
<br />L9Q
<br />EL. DISEASE -POLICY LIMIT S 1.000,000
<br />C
<br />1EmpreeTheft/Forgery
<br />,81686028 6/1/2013 6!1 /2014 Limit $1 MIL/pad. $28,000
<br />A
<br />1 Rented Equipment
<br />I,YV2Z91460659033 3/i12013 3/1/2014 Lim(k $40,DOQlltem; Died. $2,500
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) -
<br />Workers Camp is Self -Insured under California Certificate of Consent to Self Insure #1793 for California operations. APPROVED AS TO FCC
<br />Blanket GL Additional insured per form LG 10 17 09
<br />Job: #33777, Various Santa Ana Parks.
<br />07 attached, only if required by written contract,
<br />`"
<br />Additional Insured(s): City of Santa Ana, Its officers,
<br />agents, volunteers, and employees. t
<br />_
<br />CERTIFICATE HOLDER
<br />CANCELLATIO L ,
<br />I CA, #33777
<br />n
<br />pp ) 11��rr11}} City Attorney
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICISS 6E'CANCELLED BEFORE
<br />{
<br />City of Santa Ana" *' 6 i
<br />j
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: All Borujerdi
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />888 W. Santa Ana Blvd., Suite 200"
<br />"
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />5a i fie'
<br />hG f, i' Ilia
<br />Che I Feia
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />Csrtt VG Ia11 '142 1'?ENS COIJ e MI1Rlfi1-k S Ghan )(5I2011 10:M -10 1N Paue 3 o-'_ 3
<br />
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