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INSURED 5 Star Elevator Services, Inc. <br />1556 N. Case Street <br />Orange, CA 92867 <br />INSURER E <br />INSURER F; <br />Hartford Fire Insurance <br />19_682 <br />National Union Fire of PA <br />19445 <br />Preferred Employers <br />Trumbull Insurance Company _ <br />27120 <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 <br />POLICY NUMBER <br />POLICY EFF <br />MM /DDJYYYY <br />POLICY EXP <br />MMIDDtYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAWSWADE LK OCCUR <br />X <br />13UENOJ6085 <br />02125/2015 <br />02/25/2016 <br />EACH OCCURRENCE <br />$ 1,000,00 <br />PREMISES RENTED once <br />$ _ 300,00 <br />MED EXP (Any one person) <br />$ 10,00 <br />PERSONAL & ADV INJURY <br />$ 1,000,00 <br />GENT AGGREGATE LIMIT APPLIES PER <br />POLICY ® jR 0 LOC <br />GENERAL AGGREGATE <br />$ 3,000,00 <br />PRODUCTS - COMP /OP AGG <br />$ 3,000,00 <br />$ <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />COMBINED ISINGLE LIMIT <br />$ 1,000,00 <br />Q <br />ANY AUTO <br />13UENOJ6085 <br />02/2502015 <br />02/25/2016 <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />_ <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 9,000,00 <br />03 <br />X <br />EXCESS LIAR <br />CLAIMS -MADE <br />EBU060293123 <br />02/25/2015 <br />p2/25/2016 <br />I AGGREGATE <br />$ 9,000,00 <br />DED I X I RETENTION $ NIL- <br />-- <br />!Prod /Ops <br />- -- _ -- <br />$ 9,000,00 <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER /EXECUTIVE YfN <br />OFFICER /MEMBER EXCLUDED? ® <br />(Mandatory in NH) <br />NIA <br />WKN144421 -4 <br />06101/2014 <br />06/01/20151 <br />X PER 0 TH- <br />STATUTE I IER <br />E.L. EACH ACCIDENT <br />Y <br />$ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE <br />— <br />$ 11000,00 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />— <br />$ 1,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: #A -2013 -166. Santa Ana Library. City of Santa Ana is named as <br />additional insured, with regard to general liability of the named insured, <br />per attached forms CG2010 0704 & CG2037 0704. <br />5 STAR ELEVATOR SERVICES A(; R# A -2013 -166: REVIEWED E Y ,,,�� EUNI E HEVREDIA (PG. '1 of 5) <br />