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AC "R" (MM /DD/YYYY)
<br />C" CERTIFICATE LIABILITY INSURANCE
<br />F03/05/2015
<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 LICENSE NO. 0637431 M
<br />NAMEE: : PATRICK MCRAE
<br />NA _ _
<br />PATRICK MCRAE INSURANCE SERVICES tA/ °NN Ext) (714) 779 -6999 FAX No); (714) 779 -6903
<br />1290 N. HANCOCK ST., SUITE 210 E-MAIL, mcrae sbc IObal.net
<br />ADDRES: p _ g
<br />ANAHEIM HILLS, CA 92807 INSURER(S)AFFORDING COVERAGE NAIL #
<br />�^
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />INSURERA:
<br />COLONY INSURANCE CO.
<br />39993
<br />INSURED
<br />ADDL
<br />IN D
<br />INSURER B:
<br />STATE COMPENSATION INSURANCE FUND
<br />POLICY EFF
<br />JKMLRRn=
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />LIMITS
<br />INSURERC:
<br />CENTURY - NATIONAL INSURANCE CO.
<br />26905
<br />5463 DIAZ STREET
<br />x
<br />INSURER D:
<br />PEERLESS INSURANCE COMPANY
<br />24198
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />E:
<br />SCOTTSDALE INSURANCE COMPANY
<br />41297
<br />IRWINDALE CA 91706
<br />MED EXP (Any one person)
<br />-INSURER
<br />X
<br />OCP
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:
<br />RFVI.RinN NIIMRFR-
<br />GEN'L AGGREGATE LIMIT APPLIES PER :
<br />POLICY ®JE LOC
<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 />v
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />IN D
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />JKMLRRn=
<br />POLICY EXP'
<br />MM /DD /YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />XCU
<br />X
<br />x
<br />103GL000448100
<br />DEDUCTIBLE:
<br />$5,000 PER OCC
<br />06/03/2014
<br />06/03 /2015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />OCP
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER :
<br />POLICY ®JE LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />X
<br />X
<br />BAP0171987
<br />COMPREHENSIVE DED .
<br />$1,000
<br />COLLISION DED.
<br />$1,000
<br />11/05/201411/05
<br />/2015
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$ _
<br />BODILY INJURY Per accident)
<br />$ -
<br />X
<br />PROPERTY Pea cdentDAMAGE
<br />$ -
<br />E
<br />UMBRELLA LAB
<br />EXCESS LIAB
<br />X__
<br />OCCUR
<br />CLAIMS -MADE
<br />XLS009303
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />06/03/2014
<br />06/03/2015
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />- --
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />DED RETENTION $ ®
<br />_......_... e
<br />$ -
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED? V
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N /A
<br />x
<br />9101668 -2014
<br />06/03/2014
<br />06/03 /2015
<br />X IPER
<br />STATUTE ORH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />_ _
<br />$ 11000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />BUSINESS OWNERS &
<br />CBP 8641920
<br />$752,760 BUILDING
<br />CONTRACTORS
<br />$1,000 DEDUCTIBLE
<br />04/10/201404/10
<br />/2015
<br />$367,200 BPP - $300,000 BI WI EE
<br />EQUIPMENT
<br />COV. INCL. THEFT
<br />$116,318 SCHEDULED EQ.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CITY OF SANTA ANA, ALONG WITH THEIR OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS REQUIRED
<br />BY WRITTEN CONTRACT A- 2012 -177, INSURANCE AFFORDED BY THE COMMERCIAL GENERAL LIABILITY POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED
<br />IS PRIMARY INSURANCE AS RESPECTS ANY CLAIM, LOSS OR LIABILITY CAUSED IN WHOLE OR IN PART BY THE NAMED INSURED(S) OPERATIONS, AND ANY
<br />OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED EXCESS AND NON - CONTRIBUTORY.
<br />" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED.
<br />RE: CITY OF SANTA ANA/ TRAFFIC ENGINEEERING (CT 1695) CROSSTOWN OWN ELI C RI( & DA) A A- `"x-012 -177
<br />REVIEWED BY. ^° „ , EUNICE HEF�EDIA (PG. 1 Of 9)
<br />O 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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