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GRAFPRC3'-01 EWILSON
<br />_ DATE (MMIDDNYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE I
<br />1l26C2016
<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 License # 0757776 CONTACT
<br />NAME:
<br />Concord, CA - HUB International Insurance Services Inc. PHONE FAX _
<br />2300 Clayton Rd, AIC, Na, Exti: (925) 609-6500 (Arc, No): (925) 609 6550
<br />Concord, CA 94520 EMAIL
<br />AonRE M-
<br />INSURED
<br />Graffiti Protective Coatings, Inc.
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />INSURER(S) AFFORDING COVERAGE NAIC fI
<br />INSURER A: Zurich American Insurance Company 16535
<br />INSURER B . Scottsdale Insurance Comloanv 41297
<br />INSURER F :
<br />COVER AiGES IC'FRTIFIrATIF NIIMFtFP- P91fiCIrIAI NIIIMRro.
<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 HERON IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR _..._._.. ,.. ..-rADDL S UBR ............ .......— ......,..._-_-....__. __
<br />LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD�YY MMIDDfYYYY LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$
<br />CLAIMS -MADE E] OCCUR
<br />-DAIVWGE" GO -RENTED"_..—
<br />' PREMISES (Ea occurrence
<br />..-
<br />$
<br />MED EXP (Any one Person)
<br />___....-..-,.._--
<br />�...._....,.,.,.,..-_--
<br />PERSONAL $ ADV INJURY
<br />- ...........
<br />$ _._- ........ ....._
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$
<br />POLICY LOC
<br />-� JPERO l
<br />....... ..........._.._—
<br />PRODUCTS - COMPIOP AGG
<br />.....-_.-......._
<br />$
<br />OTHER'
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea aucudeni'
<br />$ 1,000„000
<br />A
<br />ANY AUTO
<br />X
<br />X
<br />BAP008640701
<br />01101/2016
<br />0110112017
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />_
<br />NOWOWNED
<br />HIRED AUTOS AUTOS.
<br />PROPERTY DAMAGE
<br />Per accident
<br />$..,..._._....
<br />UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE
<br />''.. $ 1,000,000
<br />X
<br />B
<br />EXCESS LIAB CLAIMS -MADE
<br />XLS0098753
<br />01/01/2016
<br />01101/2017
<br />AGGREGATE
<br />$ 1,000,000
<br />DED RETENTION $
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICERfMEMBER EXCLUDED?
<br />NIA
<br />X
<br />WC008640801
<br />0110112016
<br />',..
<br />0110112017
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />--..-..-- ..
<br />...._ _
<br />$ 1,000,000
<br />on N
<br />(Mandatory H)
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />.-_........
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />RE: Service Contract
<br />The City of Santa Ana„ its officers, agents, employees and representatives are included as Additional Insured per form U-CA•424-F CW (04114), as required by
<br />Written contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />9)1988-2014 ACORD CORPORATION'. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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