MODULAR BUILDING CONCEPTS, INC. - 2015

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f CERTIFICATE OF LIABILITY INSURANCE BATE 12,3'g too r) 12/30/2015 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(ies) 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 Phone: (925)930 -9464 Fax: (925) 930 -9949 STOUT INSURANCE BROKERS, INC. P.O. BOX 400 ROSEVILLE CA 95661 CONTAOT Stout Insurance Brokers, Inc. PHONE FAx Alc No E.1: 925 930.9464 ac po; (925) 930.9949 E -MAR s torts @stoutinsurance.com ADDas INSURER(S) AFFORDING COVERAGE NAIL# -- INSURERA : Covington Specialty Insurance Company 13027 Agency Llc#: OD85886 INSURED MODULAR BUILDING CONCEPTS, INC. INSURER : Progressive Insurance 11770 INSURER : National Union Fire Insurance Company 19445 12580 STOTLER CT. POWAY CA 92064 INSURERD: State Compensation Insurance Fund 35076 INSURER E PREMISESEBocceence) $ 100,000 NSURER, $ 5,000 PERSONAL B ADV INJURY COVERAGES CERTIFICATE NUMBER: 38974 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 P LICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. USE LTR TYPE OF INSURANCE AOD'L INSR SUER MD POLICYNUMBER POLICY EFF OIMIDDIYYYYI POLICY E %P fMMIDONYYYI LIMITS A GENERAL LIABILITY VBA3952400 07107/15 07107116 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE XIOCCUR PREMISESEBocceence) $ 100,000 MED. EXP(Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGO $ 2,000,000 X POLICY PRO LOC _ $ B AUTOMOBILE LIABILITY 622901922 07107/15 07/07116 COMBINEDBINGLE LIMIT (Ea acdaen0 $ 1,666,666 ALL OS X AUTOS IxANY AUTO AUTOS HIRED AUTOS X AUTOS ED UTOS BODILY INJURY (Par person) $ BODILY BODILY INJURY(Per accident) $ PRracede DNmAGE (per ecdden) $ (` X UMBRELLA UAB X OCCUR BE046157775 07107/15 07/07116 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS U CLAIMS MADE DED RETENTION 5 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE YIN OFFICERIMEMBER E %CLUOEDi (secretory In Nx) NIA 9141539.15 09 /07/15 09/07116 X WC STATU- OTH TORY LIMITC ER $ E. EACH ACCIDENT _ $ 1,666,006 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 e yea, d.eS be under DESCRIPTION OF OPERATIONS below E.L. DIS EASE -POLI CY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES SHALL BE NAMED AS ADDITIONALLY INSURED AS PER THE ATTACHED ENDORSEMENT. GERERAL LIABILITY SHALL BE PRIMARYAND NON CONTRIBUTORYAS PER THE ATTACHED ENDORSEMENT. ** THE CITY WILL BE MAILED 30 DAYS WRITTEN NOTICE OF POLICY CANCELLATION CERTIFICATE HOLDER CANCELLATION _ CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SANTA ANA, CA 92702 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A* Attention Stephen T. Stout ACORD 25 (2010105) @ 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD