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OP ID: DS <br />Al R ®A CERTIFICATE OF LIABILITY INSURANCE <br />4 <br />O04I2/12210l12014 <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 />Elkins Jones Insurance Agency <br />Inc <br />12100 Wilshire Blvd., #300 <br />Los Angeles, CA 90025 <br />Walt Storch <br />NONENCT Dana Scott AM <br />PHONE FAX <br />C No E 310.207.9796 JAIC, No: <br />ADURIess: dscott@ellkinsjones.com <br />PRODUCER CALIFB7 <br />CUB MER ID <br />INSURERS) AFFORDING COVERAGE <br />NAIL# <br />INSURED California Barricade Rentals, <br />INSURERA: IrDn9hore Specialty Ins Co. <br />EACH OCCURRENCE <br />Inc' <br />Att: Kellie Hurst <br />1550 East St. Gertrude <br />Santa Ana, CA 927D5 <br />INSURER B : Peerless Insurance Co. <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIM &MADE I OCCUR <br />INSURERC:RSUI Indemnity Company <br />22314 <br />INSURER D: State Compensation Ins. Fund <br />07/01/2013 <br />07101/2014 <br />PREMISES EREMTence <br />$ 100,00 <br />INSURER E <br />$ 10,00 <br />INSURER F : <br />S 1,000,00 <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 />L <br />TYPE OF INSURANCE <br />DLS <br />a <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDO <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIM &MADE I OCCUR <br />X <br />AGS0047600 <br />07/01/2013 <br />07101/2014 <br />PREMISES EREMTence <br />$ 100,00 <br />MED EXP(Any one person) <br />$ 10,00 <br />PERSONAL &AOV INJURY <br />S 1,000,00 <br />X BIIPD Dedct 5000 <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS. COMPIOP AGG <br />$ 2,000,00 <br />POLICY X PRO. LOG <br />jFnT F7 <br />$ <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANYAUrO <br />BA1091667 <br />0710112013 <br />07/0112014 <br />COMBINED SINGLE LIMIT <br />(EaacddanU <br />$ 1,000,00 <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per acddent) <br />$ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />PROPERTY DAMAGE <br />(PER ACCIDEW)CIOEMJ <br />$ <br />$ <br />NON - OWNEDAUTOS <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,00 <br />C <br />X <br />EXCESS LIAR <br />CLAIME -MADE <br />NHA233354 <br />0710112013 <br />0710112014 <br />AGGREGATE <br />$ 5,000,00 <br />DEDUCTIBLE <br />$ <br />$ <br />RETENTION <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />Uy descnbecnder <br />DE SCRIPTION OF OPERATIONS be. <br />NIA <br />906380813 <br />0710112013 <br />97161/2874 <br />STATU- CTH- <br />X WC Y ITS ER <br />E.L. EACH ACCIDENT <br />$ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,00 <br />E.L DISEASE - POLICY LIMIT <br />$ 000,00 <br />X+ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requlredl <br />Auto: AI GECA7010107. <br />GL:AI 6 primary per CG20370704 6 CG20100704. <br />CERTIFICATE HOLDER CANCELLATION <br />CITYSA1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana, Parks & <br />Recreation Comm Services <br />EXPIRATION <br />THE POLY PROVISIONS.E WILL BE DELIVERED IN THE <br />TH DATE <br />Agency - M23 <br />P.D. Bon 1988 <br />Santa Ana, CA 92702 <br />AUTHORRED REPRESENTATIVE <br />n A 0 <br />— JL._+.Q-X5T" <br />©1988.2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (20091109) The ACORD name and logo are registered marks of ACORD <br />