FODDRILL CONSTRUCTION CORPORATION

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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) `� 01/27/2017 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(les) must have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER Insurance 6 Surety Services, LLC 4195 Chino Hills Parkway #403 Lic. OI67797 Chino Hills CA 91709 CONTACT NAME: Gabriel Hill PHONE 9X1, (909) 203-7979 laC Ne), (909) 614-7387 A�ORIESS: gabrial@issalla.com INSURERS) AFFORDING COVERAGE NAIC# X �'I COMMERCIAL GENERAL LIABILITY CLAIMS-NIADE %❑ OCCUR INSURERA:United Specialty Insurance Core 12537 ( Y INSURED (909) 591-9096 Foddrfll Construction Corporation INSURERB:West American Insurance Comoan !44393 INSURER C: Benchmark Insurance Company_ '41394 P.O. Box 826 INSURER D: INSURER E: r Chino CA 91708 INSURER F: 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,. ILTR TYPE OF INSURANCE AOLIIUCh POLICYNUMBER fdMl0l pY EFP MMIDUY EXP LIMITS A X �'I COMMERCIAL GENERAL LIABILITY CLAIMS-NIADE %❑ OCCUR Y ( Y ATN-SPI720121 01/01/2017101/01/2018 EACH OCCURRENCE 8 1,000,000 PREMISE? Es earranca S 50,000 X Owners E Contr,Prot. MED EXP (Any one erson) S 5,000 _ PERSONAL S ADV INJURY $ 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: ''. POLICY X PRO _ JECT LOC lOTHER: GENERAL AGGREGATE $ 2,000,000 1 PRODUCTS_COMPIOP AGO $ 2,000,00D EmPI Benefits Liab$ 1,000,000 I AUTOMOBILE LIABILITY C MBINED SINGLE LIMIT 1Ea accident) $ 11000,000 B X,. ANYAUTO OWNED SCHEDULED 'AUTOS ONLY AUTOS — HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BAS(17)57472619 08/05/2016108/05/2017 1 1 _ BODILY INJURY (Par perean) $ BODILY INJURY(Per accident) S PROPERTY DAMAGE Per accident) $ $ _ A I UMBRELLA LIA9 X ' OCCUR Y Y EM1723692 01/01/2017 01/01/2018 EACH OCCURRENCE $ 3 000,000 X EXCESS LIAB CLAIMS -MADE_ AGGREGATE $ 3, 000, 000 DED X RETENTION $ 10, 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPMETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) cribe antler 0yyDESCRIP CRIPTION OF OPERATIONS haloes - NIA ( Y CST5009382 01/01/201701/01/2018 I X 1 PEATUTE ER . EL. EACH ACCIDENT 1$ 1,000,000 E.L. DISEASE EA EMPLOYEE $ 1,000,000 - E.L. DISEASE - POLICY LIMIT 3 11000,000 I I $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mora apace Is required) Certificate holder etal are additional insured per attached CG 2010 04/13 and CG 2037 07/04 endorsements. Primary wording applies per attached USIC VEX 10402 11/07 endorsement. Waiver of subrogation applies per attached CG 2404 10/93 and WC 040306 04/84 endcrsements. �p REVIEWED By;, EUNICE HE ED[ (PG City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. WTHORIZED REPRESENTATIVE 19882015 ACORD CORPORATION. All rights ADUKU 2a (;W15111J) The ACORD name and logo are registered marks of ACORD Page 1 of 1