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AEInRIY CERTIFICATE OF LIABILITY INSURANCE
<br />DATE001YYYY)
<br />zi271z7lzo13
<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(les) 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 />HUB International Insurance Services Inc.
<br />License 90757776
<br />3636 American River Drive, Suite 200
<br />Sacramento CA 95864
<br />CONTACT ROCIO Leon
<br />NAMPHONE
<br />clo Leo0-4134
<br />Eat: ac No; 915-993-7234
<br />E-MAIL
<br />ADDRESS: ROcI0,Le,n hubinternational.com
<br />INSURERS AFFORDING COVERAGE NAICe
<br />INSURER A: Greenwich Insurance Company 22322
<br />-
<br />INSURED WAREDIS-02
<br />Madison Materials
<br />P.O. Box 1318
<br />INSURER B: Westchester Surplus Lines Insurance Company 10172
<br />INSURER or Alaska National Insurance Company 38733
<br />INSURERO: Evanston Insurance Company 35378
<br />Santa Ana CA 92702
<br />INSURER E :
<br />INSURER
<br />X
<br />CERTIFICATE
<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 />TR
<br />TYPE OF INSURANCE
<br />I Ls
<br />BR
<br />POLICYNUMB
<br />MODDYE P
<br />POLICY IE P
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [�] OCCUR
<br />Y
<br />GEC8000730.03
<br />2120/2018
<br />212812010
<br />EACH OCCURRENCE $1,000.00D
<br />PREMISES Me o."Weene.)_ $10DA00
<br />X
<br />MED EXP (Any one person) $ 8,000
<br />$1,000 PO Dad.
<br />Per Ocourrenca
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />POLICY [�] PEC [:] LOC
<br />GENERAL AGGREGATE $2,000,000
<br />PRODUCTS - COMP/OP AGO $2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />AEC004538006
<br />V2812018
<br />2Y2B12019
<br />MBINEDBI 'L
<br />accitlm $ 00
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />ALLOWNED AUTO
<br />BODILY INJURY accident) $
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />ROPERTY AMAOE $
<br />Per accitlenl
<br />BI/PD Deductl1i $8,000
<br />B
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />94888$306001
<br />21112018
<br />2/2812010
<br />EACH OCCURRENCE $10000000
<br />X
<br />EXCESS WAS
<br />CLAIMS -MADE
<br />AGGREGATE $10,000,000
<br />DED RETENTION
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />OPFICERIMEMBERANY IEXCLUDPJE EGUTIVE N
<br />NIA
<br />17H WE 08450
<br />8/112017
<br />8/1/2016
<br />p
<br />X S O '
<br />ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE -EA EMPLOYEE $1,000,000
<br />(Mandatory in Me
<br />,describe under
<br />E.L, DISEASE -POLICY LIMIT $1000,000
<br />UseByes,
<br />OF OPERATIONS below
<br />D
<br />Environmental Impalrmanl
<br />LlebilIwICPL
<br />17CPLOWED0595
<br />2128/2018
<br />212812019
<br />Each Loss 1,p00,000
<br />AODmOele 1,000,000
<br />Detlucllots 10,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES )ACORD 101, Additional Remarks 6chatlule, may bo attached It more apace is required)
<br />General Liability Per Proact Aggregate applies per written contract)
<br />E: Work performed by he Insured for cedl0cate holder per Written contract.
<br />Additional Insured: City of Santa Ana, Its officers, employees, agents, volunteers and representatives
<br />Forms: CG2010 0413, CG2037 0413, 1X1405 0910, XIL431 0605
<br />REVIEWED BY: EUNICE HEREDIA (PG OF. )
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
<br />reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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