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36 (vrc <br />A "® <br />CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 <br />o2iaaizoia <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 lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />HAVE <br />Willis OP Arizona, Inc. <br />C/o 26 Century Blvd. <br />P.O. Box 305191 <br />Nashville, IN 37230 <br />PHONE , 877 -945 -7378 1 FAgiCX,.Nah 888- 467 -2378 <br />i A�°MAII r•1Eicatee(dwillie.com <br />S` <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />INSURERA: National Fire Ins. Co. of Hartford <br />20478 -001 <br />2078177299 <br />INSURED tl @F concrete Cutting, Inc. <br />INSURERS: Nationwide Mutual Insurance Company <br />- <br />23787 -001 <br />INSURERC; <br />D �1 CAFE EJiEN TED <br />P aoccurence <br />P.O. Box 10215 <br />Santa Ana, CA 92713. <br />' -" <br />INSURER 0; <br />X <br />INSURER E: <br />INSURER R <br />COVERAGES CERTIFICATE NUMBER: 21172079 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 />I NSR <br />TYPE OF INSURANCE <br />OD' <br />SUB <br />POLICY NUMBER <br />POLICY SEE <br />POLICY eXP <br />LIMITS <br />A <br />GENERAL <br />LIABILITY <br />y <br />2078177299 <br />7/18/2013 <br />7/18/2014 <br />EACH OCCURRENCE <br />$ 1 000 <br />D �1 CAFE EJiEN TED <br />P aoccurence <br />$ 100,000 <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS- MADEEXIOCCUR <br />MEO EXP An' /one poregn) <br />$ 15,000 <br />PERSONAL dADV INJURY <br />$ 1 000 000 <br />_� <br />GENERAL AGGREGATE <br />$ 2 00 000 <br />GENTAGGRCGATE <br />LIMITAPPLIES PER; <br />PRODUCTS- COMPIOP AGG <br />_ <br />$ 2 00 00 <br />_ <br />§ <br />POLICY <br />X PRO- LOC <br />B <br />AUTOMOBILE <br />LIABILITY <br />Y <br />ACP HA 7244085907 <br />7/18/2013 <br />7/18/2014 <br />(rE MBJc N ED SINGLE LIMIT <br />$ 1,000,000 <br />X <br />BODILY INJURY(Perpemcn) <br />$ <br />ANYAUTO <br />ALLOVINED SCHEDULED <br />AUT08 AUTOS <br />MIRED AUTOS NON OWNED AUTOS'%)'�'� <br />"t <br />Y INJURY PLarancidenl <br />BODI ( ) <br />$ <br />kPAUE <br />eoawlGenl <br />$ <br />UMBRBLLALIAa <br />OCCUR <br />,.. <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />_ <br />$ <br />EXCESS LIAB <br />OLAIMS -MADE <br />x' ,� <br />° <br />4� <br />DED RETENTION$ <br />$ -- <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR/PARTNERIEXECUTIVFI—I <br />OFFICER /MEMBER EXCLUDED? LJ <br />N/A <br />y <br />P,5` -+('� <br />: <br />C,(ty <br />CSTAT - O - <br />EL. EACH ACCIDENT <br />$ <br />IManda/ory,In NH) <br />Yee,doacnba under <br />DEBCRIP7ION OF OPERATIONS below <br />C.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach Aeon! 101, Addlloqul Remarks Schedule, If more space Is required) <br />Project: Job Hiring Program <br />The City of Santa Ana, it's officers, employees, agents, and representative are included as <br />Additional Insureds as respects to GanOYal Liability and Auto Liability per written contract. <br />CERTIFICATE HOLDER CANCELLATION <br />Coll:4345056 Tp1;1760214 Cert:2117V79 © 1989- 2010AQ,QIff1(j2P,Q 6ION. All rights reserved. <br />ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD k�',.xx JJ--jj JYj$ II II (1�, <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 />City of Santa Ana <br />AUTHORIZED REPRESENTATIVE <br />Attn: Purchasing Department <br />20 Civic CenL-er Plaza M -16 <br />Santa Ana, CA 92702 <br />Coll:4345056 Tp1;1760214 Cert:2117V79 © 1989- 2010AQ,QIff1(j2P,Q 6ION. All rights reserved. <br />ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD k�',.xx JJ--jj JYj$ II II (1�, <br />