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iU"-� <br />/17 ill <br />- I "—!Rbr CERTIFICATE OF LIABILITY INSURANCE <br />1r'� <br />DATE611112OIYYVY) <br />6/11/2014 <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 Bolton & Company <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />Nq E <br />PHONE Fq% <br />A a e.q (626) 799. 130O _ 626) 583-2117 <br />-M ILINSURERIS) <br />AFFORDING COVERAGE <br />NAICA <br />www.boltOnCoCO _ 0008309 <br />INSURER A: Libery Mutual Fire Insurance Company (A XVZ_ <br />23035 <br />INSURED <br />LLC <br />Merchants Building Road <br />Rd <br />1190 Monterey Pass Road <br />INSURER B: Safety National Casualty Corporation A XI)15105 <br />INSURER C; Federal Insurance Company (A++XV) <br />20281 <br />INSURER D: Liberty Insurance Corporation A XV <br />42404 <br />Monterey Park CA 91754 <br />INSURER E: Employers insurance Com�an oy fWausau (A XV)_ <br />21458 <br />INSURER F : <br />COVF_RAGFS CFRTIFICATF MIIMRFR• ann A9COO RCVI41I11M AIIIPanee. <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 />AOOL9 <br />B <br />POLICY NUMBER(MMIDONYYYI <br />POLI,ICY EFF <br />POLICY'EXP <br />IMMAXNYYYYILIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIM&MADE OCCUR <br />✓ <br />TB2Z91460659064 <br />311/2014 <br />3/1/2015 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />REMISES IEapaNccurrencaf„_ <br />300,000 <br />MEDEXP(Arryoneporson) <br />_$ <br />$ 0 <br />PERSONAL& AOV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICYE] P�ROT 7LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMPIOP AGO <br />A <br />$ 2.000.000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />A62Z91460659024 <br />WV2014 <br />3/112015 <br />COMBINED SINGLE LIMIT <br />{Ea aa'dentl <br />$ 1.000000 <br />BODILY INJURY (Pat parson) <br />__ <br />$ <br />ANYAUTO <br />AUTO ED AUTOSULEO CHEO <br />HIREDAUTOS NON -OWNED <br />_. AUTOS <br />BODILY INJURY (Pat eccidant) <br />$ <br />PROPERTY DAMAGE <br />acGtleatf <br />D <br />UMBRELLA LIAS <br />f <br />OCCUR <br />TH7Z91460659044 <br />3/1/2014 <br />3/1/2015 <br />EACH OCCURRENCE <br />$ 10 000 000 <br />AGGREGATE_ <br />$ 10,000,000 <br />exCE3$41A8 <br />CLAIMS -MADE <br />DED <br />RETENTION SO <br />$ <br />B <br />E <br />WORKERS COMPENSATION <br />AND EMPLOYERTUABILITY vlN <br />ANY PROPRIETORMARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDEI <br />(Mandatary in NH) <br />It Yes, describe under <br />OE SC RIPTIONOFOPERATIONS below <br />NIA <br />SP4050764 Excess WC (CA) <br />WCCZ90460659064(AOS) <br />4/24/2014 <br />1P1/2014 <br />4/24/2015 <br />1/112015 <br />P R TH- <br />srgmrE <br />E.L. EA CH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE•EA EMPLOYE <br />8 11000,000 <br />EL DISEASE-POLICYLIMIT <br />$ 1,000.000 <br />C <br />Emplyee I heft/Forgery <br />81585028 <br />6/1/2014 <br />6/1/2015 <br />Limit 1 MIL/Ded. $25.0110 <br />A <br />Rented Equipment <br />YM2Z91460659074 <br />3/1/2014 <br />3/1/2016 <br />Limit: $40,000/item; Ded. $2,500 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule. may be attached If more apace Is mocked) <br />Workers Comp Is Self -Insured under California Certificate of Consent to Self Insure #1793 for California operations. <br />Blanket GL Additional Insured per form LG 10 17 09 07 attached, only If required by written Contract. 'to <br />Job; #33777, Various Santa Ana Parks. ,��Ify <br />Additional Insufed(s)a City of Santa Ana, its officers, agents, Volunteers, and employees. p,P O i`(LD <br />SA STCRCKnev t <br />City of Santa Ana <br />Attn: All Borujerdi <br />888 W. Santa Ana Blvd., Suite 200 <br />Santa Ana, CA 92701 <br />ACORD 25 (2014101) <br />CYNT NO.. 2019" 1E2D CIARNT C'oLg, MG.kcll 1 <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 />AUTHORIZED REPRESENTATIVE <br />SIR <br />The ACORD name and logo are registered marks of ACORD <br />i4ancy Caft"Iider 6/11/2021 4,H0:C8 PIS :PD'PI 0mge t of I <br />