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`'� b® CERTIFICATE OF LIABILITY INSURANCE 4/16/2015 Y) 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(fes) 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 endorsement(s). PRODUCER The Contractors Choice Agency PO Box 13645 Chandler AZ 85248 NT NAME:CT Jon Rock PHONE (800)918-3584 WC .FAX .(877)684-9951 EDpAIE .JorlNnginsuranceonl ine. core INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Preferred Contractors Insurance 12497 INSURED Miller & Pidskalny Custom Woodwork Inc. 1940 Blair Ave Santa Ana CA 92705 INSURER 8: INSURER C: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:CL134420823 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. INSR LTR TYPE OF INSURANCE ADDL JNSR 8UBR AM POLICY NUMBER POLICY EFF MM DO YYV POLICY EXP M D YYV LIMITS A GENERALUABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ®OCCUR Robert Rock/JON {--�'--C�- C0006754-00 5/19/2014 --- 5/19/2015 EACH OCCURRENCE $ 11000,000 PREMISES(Ed occurrence) $ 50,000 MED EXP (Anyone person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: PRO LOC PRODUCTS - COMP/OP AGG $ 11000,000 $ q OMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NO -OWNED COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ _ er PPROa ERTn DAMAGE $ $ UMBRELLA LIAB EXCESS LAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE [--I OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- 0111 - FIR E.L. EACH ACCIDENT $ E.L, DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 181, Additional Remarks Schedule, If more space is required) The City of Santa Ana its officers, employees, agents and volunteers are named as additional insured per Form 10. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) © 1988.2010 ACORD CORPORATION. II righ,,tskes ve . INS025(201005).01 The ACORD namo apdXrp�p�r9,regtstered marks of ACORD ��V�/.C(n YJkI e3'M CC II II II 11.. � J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 Robert Rock/JON {--�'--C�- ACORD 25 (2010/05) © 1988.2010 ACORD CORPORATION. II righ,,tskes ve . INS025(201005).01 The ACORD namo apdXrp�p�r9,regtstered marks of ACORD ��V�/.C(n YJkI e3'M CC II II II 11.. � J