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MACAD4 OP ID: KG
<br />,4llk o CERTIFICATE OF LIABILITY INSURANCE
<br />DAT05129112YY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />05/29/12
<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 909-886-9861
<br />Alliant Insurance Services,inc 90986-2013
<br />(Lic-OC36861)
<br />735 Carnegie Drive, Ste 200
<br />San Bernardino, CA 92406
<br />NAME: Christina Mountz
<br />PHONE 909-474-8799
<br />Arc No Extl: AIC No): 909886-2013
<br />ADDRESS: emounttQaliiantinsurance.com
<br />INSURER(S) AFFORDING COVERAGE NAIL t
<br />5057 -Jay Freeman
<br />INSURER A: Wesco Insurance Company Inc
<br />INSURED Macadee Electrical
<br />Construction
<br />4755 Lanier Road
<br />INSURERS: RSUI Indemnity Company
<br />Travelers Property Casually
<br />INSURER C: 25674
<br />INSURER D:
<br />Chino, CA 91710
<br />INSURER E:
<br />PP105300900
<br />INSURER F:
<br />02/01/13
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POUCY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />PREMISES Ea occurrence) $ 100,00
<br />nc
<br />AqXX4
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMSMADE I OCCUR
<br />X
<br />X
<br />PP105300900
<br />02/01/12
<br />02/01/13
<br />MED EXP (Any one person) $ 5,00
<br />000 PD ded/Occ
<br />PERSONAL 6ADV INJURY $ 1,000,000
<br />GENERALAGGREGATE $ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS -COMPIOPAGG $ 2,000,000
<br />POLICY X PRO,LOC
<br />Emp Ben. $ 1,000,00
<br />AUTOMOBILE
<br />LIABILITY
<br />C!BIINED SINGLELIMIT $ 1,000,000
<br />A
<br />X
<br />ANYAUTO
<br />WPPI05300900
<br />02/01/12
<br />02/01/13
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />Y BODILINJURY Per accident)
<br />( ) $
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />;VERT DAMAGE $
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />B
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />NHA229801
<br />02/01/12
<br />02101/13
<br />_
<br />AGGREGATE $ 1,000,000
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />N / A
<br />X
<br />OTEUS5637LO5011
<br />08/15/11
<br />08/15M2
<br />X I WC STATIM 5T H -
<br />T V I ITER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE- EA EMPLOYE $ 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT 1 $ 1,000,000
<br />A
<br />Equipment Floater
<br />02/01/12
<br />02102/13
<br />Rent/Leas 75,000
<br />(Special form):El::
<br />7300900
<br />Ded 1,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is requl"),. ,
<br />Job: Broadway Sycamore Street Rewiring Project.
<br />The City of Santa Ana, its officers, agents, Volunteers and employees are
<br />additional insureds with primary and non-contributory and waiver as respects
<br />general liability per endorsements CG20100704, CG20370704 & CG24041093;
<br />waiver as respects workers compensation per endorsement WCW990376(00). S
<br />CISANTA
<br />City of Santa Ana
<br />PO Box 1988
<br />Santa Ana, CA 92702-1988
<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 />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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