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5STAR -1 OP ID: LP
<br />141 CERTIFICATE OF LIABILITY INSURANCE
<br />,i-
<br />007124/2014 4 0IY
<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 C FICATE H LDER.
<br />IMPORTANT: it the certificate holder IS an AD E 'c 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
<br />PRODUCER
<br />Jackson B Jackson Insurance CLERK OF CQuEt
<br />2220 East Route 66 Ste 205
<br />Glendora, CA 91740
<br />Corey Tobin -
<br />°T Lorl Patterson
<br />,. cNroE ,$2$.014.9944 FAX,
<br />No: 626-914-1040
<br />ADDRESS:
<br />INSURI AFFORDING COVERAGE
<br />I NAICa
<br />INSURER A: Hartford Fire Insurance
<br />19682
<br />lnsuRED 5 Star Elevator Services, Inc.
<br />INSURER a:Natlonal Union Fire of PA
<br />19445
<br />INSURER C: Preferred Employers :10900
<br />1556 N. Case Street
<br />Orange, CA 928$7
<br />-
<br />INSURER D : Sentinel Ins, Co Limited
<br />11000
<br />INSURER E
<br />02125/2014
<br />^^��
<br />v^CG /J -��
<br />INSURER F:
<br />eERT'N:ICArc MT INeeER! REVISION NUMBER:
<br />V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INUCATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSJRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TR
<br />TYPE OF INSURANCE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />POLICY HUNTER
<br />MMIDDIYYFP
<br />MMmOI EZP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERALUMBILITY
<br />�REPRESENTATIVE
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAMS -MADE C OCCUR
<br />X
<br />X
<br />13UENOJ6D85
<br />02125/2014
<br />021261201fi
<br />PREMISES Ea a mrrrenca
<br />8 300,00
<br />NED E%P(Any one oerecn )
<br />E 1Q80
<br />PERSONAL B ADV INJURY
<br />$ 1,000,08
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />d 3,000,08
<br />PRODUCTS -0OVPlOP AGG
<br />$ 3,880,00
<br />POLICY PEOT LOC
<br />OTHER.
<br />AUTOMOBILE
<br />L OUNUTY
<br />COMBINED SINGLE UNIT
<br />Es accident
<br />$ 1,D88,OD
<br />BODILY INJURY (Par resort
<br />$
<br />D
<br />ANY AUTO
<br />13UENOJ6086
<br />0212512014
<br />0212512015
<br />BODILY INJURY Per eccldent)
<br />$
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS NON�OWNED
<br />HIRED AUTOS AUTOS AUTOS
<br />PROPERTYDANAGE
<br />Peraccident
<br />$
<br />$
<br />B
<br />X
<br />UMBRELLA LIAB
<br />EXCESS DAB
<br />X
<br />OCCUR
<br />CLAIMS S -MACE
<br />EBUDIW3148
<br />02/2512014
<br />02125/2015
<br />EACH OCCURRENCE
<br />a 9,000,00
<br />AGGREGATE
<br />$ 9,000,00
<br />DIED X RETENTION I NIL!
<br />Prod /Cps
<br />is 9,000,00
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />My PROPRIETOR,PARTNERIEXECUTIVE
<br />OFFlCERIMEMBER EXCLJDED9
<br />1Mandatory In NN)
<br />If ea deacdbe under -
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />'.WKN144421-4
<br />08101/2014
<br />0810112016
<br />X STATUTE EERH
<br />_
<br />E.LEACHACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE- LAEMPLOYEE
<br />9 1,888,00
<br />E. L. DISEASE -POLICY LIMIT
<br />E 1,888,80
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tel, Additional Remarks Schedule. may be altamed Rmore apace Is required)
<br />RE: Project #13 -038 - Santa Ana Library Elevator Modernization. The City ^,N#
<br />of Santa Ana, 20 Civic Canter Plaza, Santa Ana, CA 92701; its officers, FO
<br />employees, agents, volunteers and representatives are named as additional AS 'r0
<br />insureds with regard to general liability and defense of snits arising from wpps,0 VED "-
<br />the operations and uses performed by or on behalf of the named (over) Iu �,
<br />-
<br />Lisp, E. STpRCK
<br />p{tornBY l
<br />CANCELLATION ASST
<br />CERTIFICATE HOLDER
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M36
<br />AUTHORIZ ED
<br />Santa Ana, CA 92701
<br />�REPRESENTATIVE
<br />0 1935-ZU14 ACUKU CORPORATION. ION. All rights
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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