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OP ID: DB A� Q' CERTIFICATE OF LIABILITY INSURANCE DATE ODIYYYY) 08112113 08/1 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Phone: 714-221-5200 r81 y. Insurance, BIV Inc 8181 E. Kaiser Blvd Fax: 714-221.5210 Anaheim Hills, CA 92808 John Sheffield CONTACT ONT CT NCNNo Ext: I FAX EMAIL ADDRESS: PROUuc'R HENNE,J CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE _ NAIC# _ IN _ INSURE Hennessey Hennessey & Hennessey, LLC 1760217th St„ #102, Box 246 Tustin, CA 92780 _ INSURER A: Golden Eagle ins Corporation �10836 _ INSURER B: INSURER C: INSURERD: INSURER E: INSURER F: ` COVERAGES CERTIFICATE NUMBER REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MMI�DmVY POLICYEXP LIMITS GENERALLIABILITY _ EACH OCCURRENCE $ 1,000,00 A 'X COMMERCIAL GENERAL LIABILITY CBP9595827 06106113 06106/14 REMISES fEa occur{enceL $ ____100,00 --_ CLAIhiSMADE OCCUR MED EXP(Any one person) $ 5,00 $ EXCIUde (PERSONAL&ADVINJURY GENERAL AGGREGATE j$ 2 00Q00 GRML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPiOP AGE I$ _2,000,00 POLICY Pft0- LOG $ ADTOMOSILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) _ ANY AUTO 7I BODILY INJURY (Par person) $ ALL OWNED AUTOS i'— ---- BODILY INJURY (per accident) ----"— $ SCHEDULED AUTOS PROPERTY DAMAGE A X HIRED AUTOS CBP9595827 06/06113 66/06/14 fneraccidenq $ I$ X NON -OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,OU A EXCESS LIAB CLAIMS -MADE( A CU 8374163 06/06/13 06106114 AGGREGATE - $ 1,000,00 — - DEDUCTIBLE __ $ RETENTION $ $ WORKERS COMPENSATION _ _ WC STATU OTH TORY �EL AND EMPLOYERS' LIABILITY YIN EACH ACCIDENT �$ ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBEREXCLUDED4 'Ll NIA - -- I(NI NH EI DISEASE - EAFMPLOYEEI '$ lfyes,desaibo under 0ESCRIPTION OF OPr:RAT10NS below _ �'i I? L DISEASE POLICY LOA11' _ """---- $` T' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tAHach ACORD ID1, Addltlonai Remarks Schedule, If more space I e required) *I£ cancelled for non-payment of premium only 10 days notice will be given. The City of Santa Ana, its officers empioyees, agents, volunteers and representatives are named Additiona.i Insured as respects General Liability which is primary and non-contributory. Separation of Insureds applies - ail conditions as per attached endorsements. City of Santa Ana Public Works Agency P.O. Box 1988, M36 Santa Ana, CA 92702 CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEN ©1988- rights reserved ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD