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MACAD4 OP ID: KG <br />A` ORO CERTIFICATE OF LIABILITY INSURANCE <br />�T05/291IYVYY) <br />05/29l12 <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 />MONT Christina Mountz <br />Alliant Insurance Services,inc 909 $86-2013 <br />(Lic-OC36861) <br />735 Carnegie Drive, Ste 200 <br />San Bernardino, CA 92408 <br />PHONE 909�L74-8799 <br />No A/C No): 909486-2013 <br />E-MAIL : cmounte@alilanUnsurance.com <br />5057JayFreeman <br />INSURE S AFFORDING COVERAGE <br />NAIC• <br />INSURER A: Wasco Insurance Company Inc <br />INSURED Macadee Electrical <br />INSURER 8: RSUI Indemnity Company <br />Construction <br />4755 Lanier Road <br />INSURER C . Tmvelem Property Casuatty <br />25674 <br />INSURER D: <br />Chino, CA 91710 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR N <br />TYPE OF INSURANCE <br />POUCY NUMBER <br />POLICY EFF <br />DDT <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />pREMISE3 Ea occurrence) <br />$ 100,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />X <br />X <br />PP105300900 <br />02/01/12 <br />02/01/13 <br />MED EXP (Any one person) <br />$ 6,00 <br />X 38'� PO ded/Occ <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LI MIT APPLIES PER: <br />PRODUCTS- COMP/OP AGG <br />$ 2,000,000 <br />POLICY X PRO- <br />JECT LOC <br />mp Ben. <br />$ 1,000,00 <br />AUTOMOBILE <br />LIABILITY <br />Ea ac&d,.nt)NED LIMIT$ <br />1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />X <br />ANYAUTO <br />PP105300900 <br />02/01/12 <br />02/01/13 <br />X <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIREDAUTOS X gUTONON-OWNED <br />P BODILY INJURY eraaloorrt <br />( ) <br />$ <br />Per�PROPERTY D GE <br />$ <br />UMBRELLALIAS <br />)( <br />OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />AGGREGATE <br />$ 1,000,000 <br />B <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />NHA229801 <br />02/01/12 <br />02/01M3 <br />DED I I RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />V LIABILITY <br />ANY ROPRIIE/ETROR/PARTNERIEXECUTIVE YIN <br />OFFICER(MEMBER EXCLUDED? <br />(Mandatory In NH) <br />It yyeess describe under <br />DEffi; ArOl N OF OPERATIONS below <br />N I A <br />X <br />DTEUBSBS7Lt16011 <br />08/15/11 <br />08/15/12 <br />X WC STATU• OTH- <br />I JORY LIMITS ER <br />E.L. EACH ACCIDENT <br />is 1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />E.L. DISEASE- POLICY LIMIT <br />$ 1.000,000 <br />A <br />Equipment Floater <br />WPPI05300900 <br />02/01M2 <br />02)02/13 <br />Rent/Leas 76,000 <br />(Special form) <br />Ded I'ODC <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Allach ACCORD 101, Additional Remarks Schedule, H more space Is required) <br />Job: Broadway Sycamore Street Rewiring Proqteec�t <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 A CG24041093• <br />waiver as respects workers compensation per endorsement WCW990376(00 j. <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 />V ' �1 <br />9)1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />