ORANGE COUNTY CONTRACTORS SERVICES DBA ORANGE COUNTY MAILBOXES AND CONSTRUCTION 1b - 2012

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ORANG29 OP ID: CH ^llk O CERTIFICATE OF LIABILITY INSURANCE DATE(M/YYYY) 06/0066D/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 714 - 577 -5800 Fullerton Insurance Service CDI #0596796 714 -447 -0011 1009 S. Placentia Avenue Fullerton, CA 92831 NAME: Carolyn Kamp = E>tt , 714- 577 -4517 ac No): 714 -447 -0011 E -MAIL ADDREss: cnh@fullertoninsurance.com INSURERS) AFFORDING COVERAGE NAIC # Brian Zenz Ins Agency, Inc INSURER A: Scottsdale Insurance 41297 INSURED Edward Schade & Jody Adams DBA Orange County Contractor INSURER 8: State Compensation Ins. Fund 35076 EACH OCCURRENCE $ 1,000,00 Services and Orange County INSURER C : X Mailboxes 18100 Kovac Drive #27 Huntington Beach, CA 92648 INSURER D: 05/27/12 INSURER E: PREMISES Ea occurrence $ 100,00 CLAIMS -MADE OCCUR INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE L POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X X CPS1518744 05/27/12 05/27/13 PREMISES Ea occurrence $ 100,00 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 i GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER : PRODUCTS - COMP /OPAGG $ 1,000,00 X POLICY ',. PRO- LOC $ AUTOMOBILE LIABILITY Ea BIN :D SINGLE LIMIT $ 1,000,00 A ANY AUTO CPS1518744 05/27/12 05/27/13 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS . , BODILY INJURY ( Per accident ) $ X HIRED AUTOS X NOWNED TOS x PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS -MADE - - AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X W'C STATU- OH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER E. L. EACH ACCIDENT $ 1,000,00 B ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? Fy N / A 1962458 -12 06 /01/12 06/01/13 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NH) If yes, describe under E. L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, its Officers, employees, agents, volunteers and representatives are named as additional insureds as respects to the general liability policy limits per endorsement CG2033 attached to the policy with coverage primary per endorsement GLS -295 attached to the policy. A waiver of subrogation also applies per endorsement CG2404 attached to (cont'd pg 2) CITYOFS City of Santa Ana Public Works Agency 220 S. Daisy Ave. M-85 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U 19BU -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD