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178504 Servando Varela dba XV Solutions Certificate of Insurance (page 1 of 1) 10/30/2013 12:07:23 PM Y`}DATE CERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY) 10/30/2013 THIS CERTIFICATE IS 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(les) 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 CONTACT NAME: Techlnsurance 000 1301 Central Ex South, Suite 115 :NTechInsurlaance Pyr Allen, TX 75013 PHONE Eat . (806) 666-7626 plc No : (677) 826-9067 EMAIL ADDRESS: PRODUCER CUSTOMER ID M: INSURERS) AFFORDING COVERAGE NAIC# EACH OCCURRENCE $ 2,000,000 INSURED INSURER A: The Hartford 30104 INSURER B: Servando Varela dba XV Solutions INSURER C: PREMISES Eaomu Dnra $ 300,000 344 Orange Blossom Irvine, CA 92618 INSURER D: INSURER E: INSURER F : PERSONAL &ADV INJURY S 2.000,000 A 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSftrypE LTR OF INSURANCE ADDL a BUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 ✓ COMMERCIAL GENERAL LIABILITY PREMISES Eaomu Dnra $ 300,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE 71 OCCUR PERSONAL &ADV INJURY S 2.000,000 A Yea 46SBMUV8485 928/2013 9/28/2014 GENERALAGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP/OP AGG S 4,000,000 ✓ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULEDAUTOS HIREDAUTOS PROPERTY DAMAGE (Peracadenp $ $ NON-OWNEDAUTOS UMBRELLA LIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESSLIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION VJC STATU- OTH- AND EMPLOYERS' LIABILITY YIN . L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE"=r OFFICERIMEMBER EXCLUDED? ❑ NIA E. L. DISEASE -EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS be. E, L, DISEASE -POLICY LIMIT 1 $ DESCRIPTION of OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Operations pertaining to named inured for certholder, City of Santa Ana and its officers, agents, representatives, volunteers, & employyGas are additional insured I prim wrd as respects gen'I liab per end'ts CG7158 12/03&CG7253 9/05*30 day Should any of the above •a] 61PORMhe expiration date, the issuing insurer will endeavor to mail 30 days written notice (10 days notice if due to non-payme t)- t e ce Icat older named below, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 7 e Sandoval Attorne CERTIFICATE HOLDER CANCELLATION t/ City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana' CA 92761 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD