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ACORI a CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 2/25/2013 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 -T#iE CERTIFICATEH"JD 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 - COMT CT Robin Holloway PHONE A/C No No, Wood Gutmann & Bogart Lic #0679263 15901 Red Hill Ave., Suite 100 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # Tustin CA 92780 INSURER A:Assurance Company of America /26/2013 EACH OCCURRENCE INSURED ARELL -1 INSURER B:Hartfo d Accident and $2,000,000 INSURER C :Philadelphia CLAIMS -MADE a OCCUR Arellano Associates Genoveva Arellano 5851 Pine Ave Ste A INSURER D : MED EXP (Any one person) Chino Hills CA 91709 A �G -� INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1733582079 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 INSR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY A- PPAV0�75 6 ( KU A \�-L%� AS `'f� / / /26/2013 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $2,000,000 CLAIMS -MADE a OCCUR MED EXP (Any one person) $10,000 D L� PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 (,d LI (a GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 ASbISCrI l_,1['v , "�lti.r'� $ 1-1 POLICY PRO LOC A AUTOMOBILE LIABILITY PAS037514693 /26/2012 /26/2013 Ea accident ) $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS A UMBRELLA LIAB X OCCUR PAS037514693 /26/2012 /26/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED X I RETENTION$0 $ B WORKERS COMPENSATION 2WECDQ0297 /27/2013 /27/2014 X WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $1000000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1000000 C A Errors 8 Ommissions Valuable Papers 8 Records PHSD736305 PAS037514693 /8/2012 /26/2012 /8/2013 /26/2013 2,000,000 /Claim 2,000,000 /Agg 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Job: Warner Avenue Widening Project Job No: N- 2012 -011 Certificate holder is named as additional insured on the General Liability per attached 9S2001 04 99. Primary and Non - Contributory applies on the General Liability per attached 9S2001 04 99 TE City of Santa Ana 20 Civic Center Plaza 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD