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i 0 <br />ACIORV CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIYYYY) <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />2i22i2017 <br />THIS CERTIFICATE IS ISSUED AS A MATTED 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 endorsements . <br />PRODUCER <br />NAMEaCT Cheri Greco <br />HUB Int'! - CAL Bronson <br />PHONIE 916-400-4153 1 �nx 916-993 7253 <br />r lc..N�..F t)...-......_. �Alc <br />3636 American River Drive <br />Suite 200 <br />- ---------------------- >. ---- ---- --- - <br />E-MAIL I i <br />-�senREss.CherGrecnhubnternational.com_----y=------�-�----�--------------_................. - <br />Sacramento CA 95864 <br />INSURERS AFFORDING COVERAGE NAI C # <br />INSURERA.Arch Specialty Insurance Co <br />21199 <br />INSURED INTEDEM-01 <br />INSURER B: Redwood Fire and Casualty Ins Co <br />11673 <br />Interior Demolition Inc <br />INSURER C: <br />2621 Honolulu Ave, <br />$50,000 <br />MED EXP (Any one person] <br />Montrose CA 91020 <br />INSURER D: <br />ntractors Poll <br />INSURER E <br />INSURER F <br />qXCOMMERCIAL <br />fess. Liah <br />COVERAGES CERTIFICATE NUMBER: 39469056 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 />!NSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM1DD YYY <br />POLICY EXP <br />MMlOD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />Y <br />12 EMP 71972 05 <br />6/412016 <br />6/4/2017r <br />-_AC I occuRRENcs. <br />$1,000,fl00CLAIMS-MADE <br />TOCCURDAMRGE <br />TO RENTED <br />PREMISES Ea occurrence <br />$50,000 <br />MED EXP (Any one person] <br />$5,000 <br />ntractors Poll <br />qXCOMMERCIAL <br />fess. Liah <br />PERSgN &ADV INJURY <br />$1,000,000 <br />GGREGATELIMITAPPLIESPER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />ICY PC�lLOC <br />PRODUCTS - COMPIOP ACG <br />$2,000,000 <br />$ <br />ER, <br />B <br />AUTOMOBILE <br />LIABILITY <br />01 APM 004498-03 <br />6/4/2016 <br />6/4/2017 <br />COMBINED SINGLE <br />(Ea accident) MIT <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />(Per accident) <br />BODILYINJURY (Piden! <br />S <br />NON OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY nAMAGE <br />I (Per accidents <br />$ <br />A <br />UMBRELLA LIAR <br />X <br />OCCUR <br />12 EMX 71973 05 <br />6/4/2016 <br />6/4/2017 <br />EACH OCCURRENCE <br />$5,000,000 <br />i AGGREGATE <br />$5,000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MAPF <br />DED RETENTION $0 <br />_ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIADILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />I PER 0 ]'H- <br />.,.....-..1._ST,'IT;UTE...-i �-.-- -ER— <br />E.l-. EACH ACCIDENT <br />---_....................._._...----------- <br />$ <br />OFFICERIMEMBEREXCLUDED? [—]-- <br />NIA <br />_-.-.�...�_�.____�..��.-__-�-- ---_._ <br />....................... <br />_� <br />(Mandatory in Ni <br />- <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />If yes, describe under <br />I <br />--___"------- ___-- - - <br />' <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE- POLICY LIMIT <br />$ <br />i <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS /Vi (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />RE: Work performed by the named insured underwritten contract by the certificate holder. <br />Additional Insured: City of Santa Ana where required by written contract. <br />Farms: EMP010100 0114, EMP006200 0504 <br />CERTIFICATE HOLDER CANCELLATION -- <br />O 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE <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 />20 Civic Center Plaza - Ross Annex (M) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92701 <br />AUTH.0i REPRESENTATIVE <br />O 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE <br />