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A,CC)RbP CERTIFICATE OF LIABILITY INSURANCE �-" DATE(MMlDDIYYYY) C4/18/2017 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 CONTACT NAME: Hiscox Inc. dlblal Hiscox Insurance Agency in CA 520 Madison Avenue PHCN o , (888) 202-3007 arc No): EADORIEss: contact@hiscox.com INSURER(S) AFFORDING COVERAGE NAIC #1 32nd Floor INSURER A: Hiscox Insurance Company Inc 10200 New York, NY 10022 INSURED INSURER B: Steven Hernandez INSURER C : 1521 Memcriai Drive INSURER D: Apt. C INSURER 5: Hollister CA 95023 INSURER F: COVERAGES CERTIFICATE NUMBER: RFVIRInN KRIMPER- 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LFR TYPE OF INSURANCE ADDL IN9D SUBR WVD POLICYNUMBER POLICY EFF MMlDDNYYY POLICY EXP (INIMIDENYYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR EACH OCCURRENCE $ 2,000,000 DAMAGETORENTEU PREMISES Ea occurrence $ 100,QG0 MED EXA (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 2,000,000 A UDC -1955669 -CGL -17 04/18/2017 04/18/2018 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY D JP [:] LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS - COM PLOP AGG $ SIT Gen. Agg. $ OTHER, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Ea accident BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTO$ AUTOS PROPERTY DAMAGE Per accldenl $ UMBRELLALIAS OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ D"'7 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER 07H - STATUTE ER E.L. PACH ACCIDENT $ ANYPROPRIETORIPARTNERIEXECUTIVE CFFICERIMEMBEREXCLUDE67 NfA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe Under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more apace Is required) City of Santa Ana,its officers, employees, agents, and representative are named as additional insured. Specifically the City Water Division, who services will be given to. q.IaIY V f* L.LN I Rini SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD