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.4CORD� CERTIFICATE OF LIABILITY INSURANCE
<br />2 DATE /201 MIOD Y Y)
<br />2/2014
<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
<br />Michael J Hall &Company
<br />A/E Insurance Services
<br />19660 10th Ave NE
<br />NAMEACT 24
<br />PHONE
<br />- -
<br />FAX
<br />n/c N0
<br />E -MAIL
<br />ADDRES=rtificatesQhallacdcQmpany.com
<br />Poulsbo WA 98370
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSURER A: Automobile
<br />/28/201,3yR(
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<br />INSURED 25
<br />INSURERS:Greerw chInsuranceCompany
<br />22322
<br />INSURER C
<br />MED EXP (Any one person)
<br />Dudek
<br />605 3rd Street
<br />Encinitas CA 92024
<br />INSURER D
<br />$1,000000
<br />INSURER E:
<br />Cross Liability
<br />GENERALAGGREGATE
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 431913216 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 />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />MMIDIDYI V Y
<br />MMIOOIYIWY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCURpg'�p'L3y(�
<br />X OCP /XCU /BFPO
<br />MZG80950804
<br />gCu -
<br />.¢y' A'T�l,
<br />v� A"t`
<br />r '
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<br />EACH OCCURRENCE
<br />$1,000,000
<br />D RENTED
<br />PREMISES Ea occurrence
<br />$100,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL BADV INJURY
<br />$1,000000
<br />X
<br />Cross Liability
<br />GENERALAGGREGATE
<br />$2,000,000
<br />� �
<br />` J-�(J j?,,,e�
<br />t-15� C'Ity At-Lorney
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />POLICY X PRO- L0051Stant
<br />IFDT
<br />PRODUCTS -COMNGPAGG
<br />$2,000000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MZG80950804
<br />/28/2013
<br />/28/2014
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident
<br />( 1
<br />$
<br />X
<br />NONAWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Peraccident
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />CGU32044109
<br />/2812013
<br />/28/2014
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY PROPRIETORTARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? F7
<br />N/A
<br />ZC81014322
<br />-
<br />/28/2013
<br />/28/2014
<br />X WC STATW OTH-
<br />E
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liab Claims Made
<br />PECO02403106
<br />/28/2013
<br />/28/2014
<br />1,000,000 Per Claim
<br />Contractors Pollution Uab: Occur
<br />2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is req ulred)
<br />Certificate Holders) is /are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or
<br />agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and
<br />any other insurance maintained by the Additional Insured shall be excess only and non - contributing with this insurance. A waiver of
<br />subrogation applies to the Commercial General Liability, Auto Liability, Umbrella / Excess Liability and Workers Compensation / Employers
<br />Liability in favor of the Additional Insured.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza M -37
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Z 7,4,(
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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