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ADLER-1 OP ID: PRTR <br />'Al °' CERTIFICATE OF LIABILITY INSURANCE YY' <br />° <br /> 812 <br />8127172012013 <br />0 <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(les) 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 Ileu of such endorsement(s). <br />PRODUCER <br />Phone: 951 -685-7478 CONTACT <br />Tracey <br />P <br />ieto <br /> . <br />r <br />NAME <br />Loomis Insurance Services <br />PO BOX 3128 Fax: 951-685.0665 <br />PHONE 851-6685-7478 Eax --- <br />-685-6665 <br />A/C.No EX(I,_...1 (A <br />Riverside, CA 82619 <br />Mi <br />h <br />l J R E-MAIL <br />aoDPass, t rieto@joomis4insurance_com <br />? <br />c <br />ae <br />unner <br /> NSI1.ReR(S)APFORDING COVERAGE NAIC0 <br />-, INSURERA: Northfield (nsuraq COttlpan_y _ <br />INSURED Adierhorst International, Inc. INSURERS; <br />3951 Vernon Avenue <br /> <br />id <br />Ri <br />CA 92509 INSURERC: <br />vers <br />e, <br /> INSURER D : <br /> _ <br />INSURER E: <br /> INSURER P : <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 />TYPE OF INSURANCE A DL $UBR I'"---'?-- <br />POLICY NUMBER -POLICY EFF <br />MMt DIYYYY POLICY EXP <br />M IDDIYYYY <br />LIMITS <br /> oENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY I X WS178749 0810812013 0810812014 PREMISES Ea nccurrencel $ 100,00 <br /> CLAIMS-MADE n OCCUR MEO EXP(Anyenepamon) $ 8,000 <br /> PERSONAL is AOV INJURY $ 1,000,000 <br /> GENERALAGGREGATE $ 2,000,000 <br /> GENTAGGREGATE LIMITAPPLIESPER: PRODUCTS_COMP/OP AGO $ <br /> X POLICY PRO- LOC S <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> <br />ANY AD TO <br />BODILY INJURY (Per Person) _ <br />S <br />s <br /> ALI. OWNED SCHEDULED <br />AUTOS <br />AUTOS BODILY INJURY (Per accldenp $ <br /> NON-OWNED <br />q PROPERTY DAMAGE <br />$ <br /> HIRED AUTOS AUTOS Peraci; s 1 <br /> S <br /> UMBRELLA LIAR OCCUR <br />_ <br />EACH OCCURRENCE <br /> EXCESS LIAR CLAIMS-MADE A <br />APPROVED A TO-F® AGGREGATE <br /> _ <br />DED RETENTIONS $ <br /> WORKERS COMPENSATION WCSTATU- OTH- <br /> AND EMPLOYERS' LIABILITY ' LOR _ IMITS <br /> YIN <br />' <br /> ANY PROPRIETORIPARTNERIEXECU <br />WE <br />NIA Laura A <br />Laura A <br />Ossini E L EACH ACCIDENT S <br /> OFFICERfMEMBER EXCLUD507 ( . <br />. <br /> (Mandatory in NH) <br />C <br />?ttOYUC E.L DISEASE - EA EMPLOYEE S <br /> IF yes, describe under fl <br />AsS15Laffi$ L <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attaoh ACORD 101, Additional RomAII(S Schedule, If more spaoo IS required) <br />The City of Santa Ana, its officials, officers, employees, agents and <br />volunteers are named as additional insureds. <br />The City of Santa Ana <br />P O Box 1988 <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />CORPORATION. All rlahts reservad <br />ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD