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AcoRL7rCERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIOOIYYYYj
<br />4/1/zols
<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 pollcy(les) 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 />PRODUCERCI
<br />Landscape Contractors (Lic#0755906)PHC
<br />Insurance Services, Inc.
<br />1835 N. Sine Avenue
<br />Fresno CA 93727
<br />ME: T Benita Hall, CISR
<br />_
<br />NE I: (559) 650-3555 FAX
<br />Noe tss3)sso-ssse
<br />,bhall@lcisinc-com
<br />MSURERS AFFOROING COVERAGE NAIC#
<br />INSURERA.Atlantic Specialty Insurance 27154
<br />INSURED
<br />Mariposa Landscapes Inc F4' --c
<br />15529 Arrow Highway
<br />Irwindale CA 91706
<br />INSURERB:Navig_atoxs Specialty Ins Co 36056
<br />INSURERc:
<br />INSURER D:
<br />INSURERS:
<br />INSURER.:-
<br />COVERAGES CERTIFICATE NUMBER:16/17 Pkg,Auto & Umb REVISION NUMBER:
<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 HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />TYPE O.INSURANCE
<br />POLICY NUMBER
<br />IADOLSUBR ODIYYYCY F
<br />MMIDDIYYYLICY P
<br />LIMITS
<br />GENERAL LIAEILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />PREMISE^ negoe $ 500,000
<br />A
<br />X COMMERCIALGENERALLIABLITY
<br />CLAIMS -MADE ®OCCUR
<br />618-00-11-21-0000
<br />/1/2016
<br />/1/2017
<br />MED EXP(.4ny,or,e peronj $ 5,000
<br />PERSONAL S AOA&IJURY $ 1,000,000
<br />X1 $1,000 Pd Ded
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER
<br />PRODUCTS -COMPIOP AGG $ 2,000,000
<br />X POLICY
<br />PRO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />EINIB,1'1111LS%`INGLE LVAITA 11000,000
<br />y9`
<br />X
<br />AHr AUTO
<br />ALL OVAIEG "CFI'D'LLEU
<br />AUT03 AVl`JS
<br />618-00-11-21-0000
<br />/1/2016
<br />/i/20Y7
<br />BODILY INJURY (Par persolr) $
<br />BODILY IPIJIJP.'!(Par arwaeMl
<br />NONoVVED
<br />HIREDAUTOS' AUTOS
<br />P'ROPF,RI'Y DAMACa'E $
<br />(pJ,domr
<br />_
<br />Uninsured maroriri mAbmeU $� 2-000,000
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR-�
<br />EACH OCCURRENCE $ 5,000,000
<br />B
<br />EXCESS LIAR
<br />CLAIMGMADE
<br />AGGREGATE $ 5,000,000
<br />DED RETENTION,
<br />5616EXC840614IC
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PRORRIETORIPARTIJER/ERECUTIVEE.L.
<br />OFTICERMNIE(MI in NHR EXCLUDELY)
<br />NfA
<br />VW STATU- 01'H -
<br />TORY LIMITS ER
<br />EALH ACCIDENT
<br />E.L. DSEASE-EA EMPLOY $
<br />DE54'P.IPTIriIJ OF GPERATIOfIE balcv,
<br />„rs �iV��
<br />X1CA5
<br />F..L. DISEASE-POLK'Y LIMIT $
<br />.N�y
<br />DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (AtlachACORD 101,Atldlllon emarka Sc ora space lxroqulrad)
<br />RE: All landscape operations performed by or on behalf the named insured
<br />Blanket Additional insured per attached OBPGGLO4340414
<br />City of Santa Ana, it's officers, employees, agents and representatives (Excluding Professional
<br />Liability) are named as additional insured
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Attn: Purchasing Department
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana„ CA 92701
<br />B Hall, CISR/HRODEL
<br />ACORD 25 !20701051
<br />INS025 (2nloc,IOI The ACORD name and logo are registered marks of ACORD
<br />TInnI All rinhrc --.d
<br />
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