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<br />ACORH CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDIYYYY)
<br />12/30/2016
<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
<br />CONTACT Arlaria De Leon
<br />NAME:
<br />WEEz : (805) 585-6145 FANo: (805)585-6245
<br />Tolman & Wiker Insurance Services LLC #OE52073
<br />E-MAIL
<br />ADDRESS: adeleon@tolmanandwiker.com
<br />196 S. Fir Street
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />PO BOX 1388
<br />INSURER A:Hartford Fire Ins Cc 19682
<br />Ventura CA 93002-1388
<br />INSURED
<br />INSURER B:Hartford Casualty 29424
<br />INSURERC:Hartford Accident & Indemnit 22357
<br />Pacific Coast Cabling, Inc.
<br />INSURER D :
<br />DBA: PCC Network Solutions
<br />INSURER E :
<br />20717 Prairie Street
<br />INSURERF:
<br />Chatsworth CA 91311
<br />COVERAGES CERTIFICATE NUMBER:17/18 GL/AU/UMB/WC 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 />INSR
<br />LTR
<br />OF INSURANCE
<br />ADDLSUBRTYPE
<br />INsn
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM DY EXP
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />CLAIMS -MADE OCCUR
<br />72UUNJH0752
<br />j6/ j
<br />1/2018
<br />DAMAGE TO RETE
<br />PREMISES Ea occur ence $ 300,000
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />��dias
<br />10
<br />`✓
<br />GEML AGGREGATE LIMIT APPLIES PER:VV
<br />GENERAL AGGREGATE $ 2,000,000
<br />POLICY PE� 7 LOC
<br />r
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />- $
<br />OTHER:
<br />I
<br />i..
<br />O��K
<br />0
<br />p'
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NON -OWNED,
<br />AUTOS
<br />A 5$i$ aft CI
<br />72UUNJI10752
<br />y `A1,,.,�
<br />,�"
<br />1/1/2017
<br />Vr
<br />©('"
<br />1/1/2018
<br />(Ea accident LIMIT $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />X
<br />UMBRELLA LABX
<br />OCCUR
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE $ 10,000,000
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED 1 X I RETENTION 10,000
<br />$
<br />72RHUJH1103
<br />1/1/2017
<br />1/1/2018
<br />WORKERS COMPENSATIONXI
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OT
<br />STATUTE I ERH
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />C
<br />/iEXCLUDED? ❑
<br />(Mandatoryn NH)
<br />NIA
<br />72WEEQ8250
<br />1/1/2017
<br />1/1/2018
<br />E.L. DISEASE- EA EMPLOYE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />GL: The City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional
<br />Insured as respects to operations of the Named Insured per attached HG0001 0605. This insurance is
<br />primary and non-contributory to any other insurance held by Additional Insured per attached HG0001 0605.
<br />A Waiver of Subrogation is added per attached HG0001 0605. Attached enorsements apply only as required by
<br />written contract during the policy term.
<br />CERTIFICATE HOLDER CANCELLATION
<br />cmarek@santa-ana.org
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn : Insurance Services Division M-12 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />R Toohey, CISC/ARIAND—�1
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 (2014n1)
<br />
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