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AcoRRJ® CERTIFICATE ®F LIABILITY INSURANCE
<br />DATE 2/29/2015
<br />12/29/2015
<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 Ariana De Leon
<br />NAME:
<br />Tolman & Wiker Insurance Services LLC #OE52C73
<br />PHONE(805)565-6145 Alc No:(sos)ses-szas
<br />EMAIL adeleon@tolmanandwiker.com
<br />ADDRESS:
<br />196 S. Fix Street
<br />PO Box 1388
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A:HartfOrd Fire Ins Cc
<br />19682
<br />Ventura CA 93002-1388
<br />INSURED
<br />INSURER B:Hartf ord CasualtV
<br />29424
<br />INSURER C:Hartford Accident & Indemnity
<br />22357
<br />Pacific Coast Cabling, Inc.
<br />INSURER D:
<br />MED EXP(Any one person) $ 10,000
<br />DBA: PCC Network Solutions
<br />INSURER E:
<br />20717 Prairie Street
<br />INSURER F:
<br />1/1/2016
<br />TO .KO
<br />AA
<br />Chatsworth CA 91311
<br />COVERAGES CERTIFICATE NUMBER:16/17 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 />TYPE OF INSURANCE
<br />ADDLSUBR
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />POLICY NUMBER
<br />POLICYEFF
<br />MMIDDNYYY
<br />POLICY EXP
<br />MMIDDIYYVV
<br />LIMITS
<br />Plaza
<br />X COMMERCIAL GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, QA 92701
<br />R Toohey, CISC/ARIAND�_-
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />CLAIMS -MAGE OCCUR
<br />DAMAGE T RENTED 300,000
<br />PREMISES Ea occurrence $
<br />MED EXP(Any one person) $ 10,000
<br />72UUNJH0752
<br />,R VF1D
<br />1/1/2016
<br />TO .KO
<br />AA
<br />T1r/x1/2017
<br />1°y
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />POLICY JECT � LOC
<br />.L'k�
<br />-
<br />CCL��
<br />PRODUCTS - COMPIOP AGO $ 2,000,000
<br />Employee Benefits $ 1,000,000
<br />OTHER:
<br />`
<br />Y,
<br />AUTOMOBILE
<br />LIABILITY
<br />(�
<br />t Cj
<br />y Attorn B
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />BODILY(EddINJURY(Per person) $
<br />A
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS
<br />sistan
<br />72UUNJH0752 4
<br />Q d
<br />1/1/2016
<br />e Jlo
<br />1/1/2017
<br />na
<br />BODILY INJURY (Per accident) $
<br />$
<br />Pena accident)
<br />Underinsuretl matodsl $
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />1
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE $ 10 000,000
<br />B
<br />EUl
<br />CLAIMS -MADE
<br />(,
<br />DECED X RETENTION$ 10,000
<br />1 $
<br />72RHUJR1103
<br />1/1/2016
<br />1/1/2017
<br />O
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE ❑
<br />OFFICER/(MandatoryEMBER In NH EXCLUDED?
<br />( ry )
<br />NIA
<br />72i4EEQS250
<br />1/1/2D16
<br />1/1/2017
<br />-
<br />X PER 'ER'-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000 000
<br />If yes, describeunder
<br />DOF O
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 11000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 EG0001 0605. Attached enorsements apply only as required by
<br />written contract during the policy term.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014/01)
<br />INS025 r2m4nn
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />cmarek@santa-ana.org
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Insurance
<br />Services Division M-12
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center
<br />Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, QA 92701
<br />R Toohey, CISC/ARIAND�_-
<br />ACORD 25 (2014/01)
<br />INS025 r2m4nn
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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