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178504 Servando Varela dice XV Solutions Certificate of Insurance (page 1 of 1) 12110/2012 12:09:02 PM <br />AGClRf� CERTIFICATE OF LIABILITY INSURANCE <br />t,� <br />012/10 /2012 ) <br />12/10/20, 2 <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 <br />CONTACT <br />NAME: <br />Techlnsurance <br />AI_ Ext: (800) 668 -7020 (AID No) :(972) 390 -8484 <br />ABDRESS: <br />PRODUCER ---- - - -_ -- <br />1301 Central Expy. South, Suite 115 <br />Allen, TX 75013 <br />CUSTOMER ID N: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />EACH OCCURRENCE <br />INSURED <br />INSURER A: The Hartford <br />30104 <br />INSURER B : <br />Servando Varela dba XV Solutions <br />INSURER C : <br />344 Orange Blossom <br />Irvine, CA 92618 <br />INSURER D: <br />CLAIMS -MADE IV] OCCUR <br />INSURER E <br />INSURER F: <br />MED EXP (Any one person) <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 />rypE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />MMIODNYYV <br />POLICY EXP <br />(MMIDDNYYYI <br />LIMITS <br />AUTHORIZED REPRESENTATIVE d <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,000 <br />✓ COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES (Ed occurrence) <br />$ 300,000 <br />CLAIMS -MADE IV] OCCUR <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL& ADV INJURY <br />$ 2,00,800 <br />A <br />Yes <br />46SBMUV8485 <br />9/28/2012 <br />9/2812013 <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMPIOP AGO <br />$ 4,000,000 <br />✓ POLICY PRO- <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea ee.bmh <br />$ <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />PROPERTY DAMAGE <br />i <br />(Per amdenq <br />$ <br />$ <br />NON -OWNED AUTOS <br />UMBRELLA LIAR <br />OCCUR <br />-� <br />� <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />S <br />EXCESS LIAB <br />CLAIMS -MADE <br />4 F✓+` <br />Ta S <br />Oty( <br />_ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY YIN <br />ABSIStartt <br />WC STATU- OTH- <br />U E <br />ANY PRO PRI ETOR /PARTN ER/EXECUTIVE <br />E.L EACH ACCIDENT <br />$ <br />OFFICERIMEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />Operations pertaining to named inured for certholder, City of Santa Ana and its officers, agents, representatives, volunteers, & employees are additional insured / <br />prim wrd as respects gen'I liab per end'ts CG7158 12/03 &CG7253 9/05 "30 day Should any of the above described policies be cancelled before the expiration <br />date, the issuing insurer will endeavor to mail 30 days written notice (10 days notice if due to non - payment) to the certificate holder named below, but failure to do <br />so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE <br />WILL BE DELIVERED IN <br />20 Civic Center Plaza <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE d <br />© 1988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />