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,mac " CERTIFICATE OF LIABILITY INSURANCE DATE {MMIDWY'YYY)
<br />9/29/2014
<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 Risk sS7. trace Company CONTACT
<br />NAME:
<br />_... _.. ._ Company 2040 Main tereS et, Suite 450 PHONE
<br />PAX
<br />Irvine, CA 92614 l #/G.. N ExtH 949-242-9240 _.._ m (Arc, NeL
<br />F -MAII
<br />www.risk-strategies.com
<br />INSURED
<br />T & B Punning, Inc.
<br />17542 E. 17th Street, Suite 100
<br />Tustin CA 92780
<br />CA DOI License No. OF06675
<br />INSURER(SI AFFORDING COVERAGE NA IC it
<br />INSURER A: 'Travelers Property Casualty Co. of America 25674 _
<br />INSURER B : Travelers Indemnity Co. of Connecticut 25682
<br />INSURER C: Allmerica Financial Benefit Ins Co 41840
<br />INSURER D: Continental Casualty Gampany. -- 20443
<br />INSURER E : — . -.
<br />(COVERAGES CFRTIFIf:ATF NIIMRFR- 01-17r4An PRI/l CInIld Mil ILIIVUIPD�
<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 - ...... .__...... AD, L SUBR _. .. ........ ....._ .. ...- P4LICY EFF __.. POLICY E .....- ._ -.... _ _......_ -._ ..........._..---
<br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMfDDfYY XP LIMITS
<br />A
<br />Y,r COMMERC @AL GENERAL LIABILITY
<br />680708OP051
<br />21112014
<br />2/1/2015
<br />EACH OCCURRENCE
<br />$ $2,000,000
<br />B
<br />CLAIMS -MADE / OCCUR
<br />6801E176797
<br />21112014
<br />211/2015
<br />D f ACi7 _T()R9NTEO
<br />_
<br />$1,000,000
<br />PREMISES Ea occurrence)
<br />$
<br />i
<br />MED EXP Q ny one person)
<br />$ $10,000
<br />PERSONAL & ADV INJURY
<br />$ $2,000,000
<br />I GEN L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ $4,000,000
<br />,. PRO-
<br />POLICY ✓ 'EC ..,, LOC
<br />._........ _ ..,..._.
<br />PRODUCTS - GOMP(OP AGG
<br />$ $4,000,000
<br />OTHER:
<br />$
<br />C
<br />AUTOMOBILE
<br />_-
<br />LIABILITY
<br />AW3A21249700
<br />2/1/2014
<br />2/112015
<br />COMBINED S #NGLE LIMIT
<br />(Ea accident)—
<br />$
<br />$1,000 „000
<br />, - .. .._.....
<br />✓
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />-
<br />$
<br />..
<br />ALL
<br />AUTOS OWNED SCHEDULED
<br />..�.... )
<br />BODILY INJURY (Per accident
<br />.....f
<br />-___ ,,...._,_........_. --
<br />$
<br />NON -OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />Pea DAMAGE
<br />_....
<br />$
<br />A
<br />I ✓
<br />_...
<br />UMBRELLA LiAB ,/' OCCUR
<br />CUP1 E10983A
<br />��. 2/1/2014
<br />2/112015
<br />EACH OCCURRENCE
<br />$ $2,000,000
<br />EXCESS LIAB CLAIMS - MADE'.
<br />AGGREGATE
<br />$ „_...- $2,000,000
<br />DED +/ RETENTI,N$O
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />UB4212T523
<br />2/1/2014
<br />211/2015
<br />d srnTJTE OTH
<br />AND EMPLOYERS' LIABILITY YIN
<br />..$ .� .
<br />ANY PROPRIETORJPARTNERIEXECUTIVE
<br />E.L. EACH ACCIDENT
<br />—
<br />$1,000,000
<br />EXCLUDED? ❑
<br />NIA
<br />-
<br />E.L. DISEASE- EA EMPLOYE.'...$
<br />-. -. ......_
<br />$1,000,000
<br />FFICEIoMEnMSER
<br />(Mandatory )
<br />If es, describe under
<br />.. ..... .... .........._
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ $1,000,000
<br />L7
<br />PTOfessio al Liability
<br />MCH288294144 9120/2014
<br />9120/2015
<br />Per Claim: $1,000,000
<br />Aggregate: $2,000,000
<br />DESCRIPTION Of OPERATIONS t LOCATIONS i VEHICLES (ACORD 101, Additional. Remarks Schedule, may he attached If more space Is required)
<br />Projects as on file with the insured including but not limited to San Lorenzo Lift Station $: San Lorenzo Lift . Station IVIND. City of Santa Ana is named
<br />as additional insured on the general liability policy -see attached endorsement.
<br />k,rK.I li °It RilC MULL Fr_K k;AN(;hLLAIIUN I
<br />City of Santa Ana
<br />Public Works Agency
<br />Corporate Yard, M-84
<br />220 S. Daisy Ave.
<br />Santa Ana CA 92703
<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 />Michael Christian
<br />1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />CERT NO,: 217151.44 Sherry Young 9/2912014 9:39:,7.9 trhl (PDT) Page 1 of 3
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