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Client#: 1259431 305CORDOCOR
<br />ACORD,. CERTIFICATE OF LIABILITY I SU NCEDATE(MM/DD/YYYY)
<br />1/16/2015
<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 NAMEACT Christy Mata
<br />&T Insurance Services pwC, 714 941-2870_ Fizz
<br />(_A/C, No, Ext): --------------—�(A/C,._._._..----------
<br />of Orange County ADDRESS: CMata@bbandt.Com
<br />2400 Katella Avenue Ste 1100 INSURER(S) AFFORDING COVERAGE _ NAIC #
<br />Anaheim, CA 92806 INSURER A: Travelers Property Casualty Co 25674
<br />INSURED
<br />Cordoba Corporation
<br />1401 N. Broadway
<br />Los Angeles, CA 90012
<br />INSURER B :
<br />- --
<br />INSURER c
<br />—
<br />INSURER D
<br />INSURER _E:
<br />INSURER F:
<br />ADDL
<br />INSR
<br />COVERAGES CERTIFICATE NLIMRFR- RFVICInM All INIRFR.
<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 CONTRACTOR 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 />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />6306C828151TIL15
<br />01/20/2015
<br />01/20/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL_ GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$300,000
<br />MED EXP (Any one person)
<br />_
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />_
<br />$ 2,000,00_0
<br />POLICY PRO LOC _
<br />X JECT
<br />$
<br />A
<br />AUTOMOBILE LIABILITY
<br />81OOE226433TIL15
<br />01/20/2015
<br />01/20/201
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />A
<br />X UMBRELLALIAB X OCCUR
<br />CUP6C828151TIL15
<br />01/20/2015
<br />01/20/201
<br />EACH OCCURRENCE
<br />$10,000000
<br />EXCESS LIAB CLAIMS -MADE
<br />- __ ................ _—._-.... ..-..-._
<br />AGGREGATE
<br />.._..-- ---- ...-----._
<br />$10,000,00-0--____
<br />__
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE �
<br />OFFICERIMEMBER EXCLUDED? :N
<br />NIA
<br />_
<br />_
<br />UB6C870992TIL15
<br />01/20/2015
<br />_
<br />01/20/201
<br />X WCSTAMIT OTH-
<br />TORY LIMIT ' ER
<br />_
<br />E.L. EACH ACCIDENT
<br />_
<br />$1,000 000
<br />-- --
<br />E.L. DISEASE - EA EMPLOYEE
<br />--
<br />$1,000,000
<br />J
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />_
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />CORDOBA
<br />CORPORATION AG
<br />E
<br />FIU
<br />A-2011-193-04 REVIEW
<br />_Y
<br />E Y � �
<br />G� �..
<br />_
<br />`a EUNICE HEREDIA (PG 1 OF 6)
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Certificate Holder is named as Additional Insured, as respects General Liability, as required by written
<br />contract per the attached form CGD4140408 pg 1 and 2 of 2.
<br />Primary Wording applies, as respects General Liability, as required by written contract per attached form
<br />CGD4140408 pg 1 and 2 of 2.
<br />Additional Insured amended to include: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
<br />(See Attached Descriptions)
<br />City of Santa Ana
<br />Transportation & Traffic Engineer Public
<br />Works Agency M-93
<br />Attn: David Biondolillo, 20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />O 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE 'THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />
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