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AC RH CERTIFICATE OF LIABILITY INSURANCE <br />aposos2a, <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ 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 IN$URER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder la an ADDITIONAL INSURED, the poHcy(los) must have ADDITIONAL INSURED provisions or be endorsed. <br />H SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an <br />this Certificate does not confer rights to the certificate holder in lieu of such endorsement a . <br />PRODUCER <br />,S$atsftfi RIC VVEISSINGER,AGENT - LIC #OC89161 <br />WEISSINGER INSURANCE AGENCY INC <br />5922WARNERAVE <br />HUNTINGTON BEACH, CA 92649 <br />NONE CT CAROLE COOK <br />PNHONE 714377-1111 yC.N .714377-1611 <br />EMAIL <br />iij <br />INSUREP431 AFFORDING COVERAGE NAIC0 <br />INSURERA a State Farm General Insurance Company 25151 <br />INSURED <br />OC SAFETY INC <br />1940 N TUSTIN ST, STE 103 <br />ORANGE, CA 928664642 N-2018-030 <br />INSURERE: <br />INSURER C : <br />INSU R ' <br />INSURE'RE: <br />INSURER F: <br />COVERAGE$ CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 'PERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I SR <br />TYPE of INSURANCEXj <br />APLUBR <br />P NUM <br />OLICYEACH <br />D CY EPP <br />P <br />LIMITS <br />ORNERAL UAahITY <br />OCCURRENCE S 1.000.000 <br />®OCCUR <br />_ <br />M=mCLAIMS-MADE <br />�ylaal g-160,098 4 <br />—` <br />MCCEXP A bna areon $ 5,000 <br />x <br />A <br />A <br />92-EA4145.9 <br />07/01/2017 <br />0710V2018 <br />-RY "S 11000.000 <br />PERSONAL ADVINJURY 8 <br />GEN'LAGGREGATE LIMIT APPLIES PER; <br />GENERALAGGREGATE S 2,000.000 <br />POLICY ❑ jE� ® LOC <br />PRODUCTS.DOMPIOPAGG 5 2,000,000 <br />s <br />OTHER: <br />AUTOMOBILE <br />LIAMILTY <br />MRI EG IN LPAI s <br />ANYAUTO <br />BODILY INJURY (Per PeroW S <br />0ANRD sCMEWLED <br />AUTOS ONLY Aur <br />aODIY INJURY(Psraccldmt) S <br />HIRED NONXIWTIEO <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY OAMAGE S <br />e <br />s <br />UMBRELLA WeOCCUR <br />I <br />EACHOCCUR ENCE <br />AGGREGATE S <br />EXCESS MECWIMSMADC <br />ED I I RETENTION" <br />S <br />WORKERS COMPENSATION <br />BIND EMPLOYERE'LWBWTY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE �I <br />OPPICERNMedai EXCLUDED? F <br />NIA <br />tRT E RH— <br />__—' <br />E.L. EACH ACCIDENTmm$� <br />E.L. DISEASE -EA EMPLOYE S <br />(Mandatory In NH) <br />IP M tlBBtlI0N 540' <br />D ORIPTION OF OPERATIONS below <br />_...__ <br />- POLICY <br />E.L. tlI5EA9E�M0LIOY LIMIT S _ <br />BUSINESS PROPERTY <br />_ <br />I <br />X <br />92 -EA -V145.9 <br />07/01f2017 <br />0710,12018 <br />bESCMPRGN OP OPERAnON6 f LCCATION6 / VEHICLE6 iACORD tsi, Atltlltlsnsi Ra1naH16 6ehatlule, maybe atlsebed N mo,c spans is reg4lretll <br />LCC 01 -1940 N TUSTIN ST, STE 103, ORANGE, CA 92865 <br />CERTIFICATE HOLDER, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL <br />LIABILITY <br />CITY OF SANTA ANA <br />ATTN: PURCHASING DEPARTMENT <br />20 CIVIC CENTER PLATA <br />SANTA ANA, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />0 <br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD <br />All ITQhts reserved. <br />1001460 iS284e.d2 Ub18id014 <br />1 � <br />