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GRAFPRO-01 KJY01
<br />CERTIFICATE OF LIABILITY INSURANCE 1DATE/4/2(MMIDDIYYYY,
<br />017
<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 INISURER(S), AUTHORIZED
<br />_-REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions of be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such enclorsementi
<br />PRODUCER License # 0757776 CONTACT
<br />NAME:
<br />Concord, CA - HUB International Insurance Services Inc. PHONEFAX
<br />2300 Clayton Rd. (A/C, No, Exii (925) 609-6500 (925) 609.6550
<br />Concord, CA 94520 E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC it
<br />INSURER A: Liberty Mutual Fire Insurance Company 23035
<br />INSURED INSURER B: Scottsdale Insurance Company 41297
<br />Graffiti Protective Coatings, Inc.
<br />INSURERC:
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />INSURER D
<br />INSURER E
<br />INSURER F
<br />P111%/Pi
<br />rr_DTICl kiiiiutioam
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POl PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
<br />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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY i
<br />LTR, INSD WVD IMMIQDfYYYYI IMMIDDNYYYI
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMSES (Fa occurrence) $
<br />MrD EXP (Anyone persori} 3
<br />PERSONAL & ADV INJURY S
<br />GEN'L AGGREGATE LIMIT APPLIES I
<br />GENERAL AGGREGATE S
<br />Pi
<br />POLICY JECT LOC
<br />PRODUCTS - COMP/OP AGG S
<br />OTHER,
<br />S
<br />A AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,0001
<br />(Ea accident) S
<br />X ANY AUTO X X AS2Z91466837017 01/01/2017 0110112018
<br />BODILY INJURY (Per person) S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident). $
<br />Hi[RED NON -OWNED
<br />PROPERTY DAMAGE
<br />AUTOS ONLY AUTOS ONLY
<br />(Per accident) $
<br />B UMBRELLA LIAR OCCUR
<br />EACH OCCURRENCE $ 5,000, 000
<br />X EXCESS LIAB CLAiMS-MADE XLS0101228 01/01/2017 01/01/2018
<br />5,000,000
<br />AGGREGATE S
<br />DIED RETENTION $
<br />. ...... ..... ..
<br />$
<br />A WORKERS COMPENSATION
<br />PER OTH-
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />STATUTE ER
<br />R ANY PROPRIETORYPARTNEEXECUTIVE X WC2Z91466837027 0110112017 01/01/2018
<br />E.L. EACH ACCIDENT S 1,000,000
<br />OFFICER/MEMBER EXCLUDED? NIA (Mandatory in Ni
<br />1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - EA EMPLOYEE $
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 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
<br />form AC 84 07 07 13. Waiver of Subrogation
<br />lapplies to Auto Liability per AC 84 07 07 13 and Workers Compensation per attached WC 04 03 06, all as required
<br />by written contract.
<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 />AIL;Vl ZO [;!Ulb/il @ 1988.2015 ACORD CORPORATION, All rights reserved,
<br />The ACORD name and logo are registered marks of ACORD
<br />k2-,V4CWW) -VYV-,
<br />
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