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ACORD CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) '" 03/28/2005 PRODUCER (714)905-1923 FAX (714)905-1910 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hayward Tilton & Rolapp Ins. Assoc., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License #0614365 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 25529 Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC# INSUReD Hernandez Cart Service, Inc. INSURER A Nautilus Insurance Company 1808 Lincoln Blvd. ~RB: State Compensation Ins Fund Venice, CA 90291 INSURER C INSURER 0 INSURER E COVERAGES THE POLICIES OF INSURANCE USTED 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 \^JHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUC1ES. AGGREGATE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~$': i,~9,;: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PgLlCY EXPIRATION LIMITS ~NERAL LIABILITY NC400101 03/04/2005 03/04/2006 EACH OCCURRENCE I 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I 50~ =1=J CLAIMS MADE 0 OCCUR ~D EXP (Anyone person) . 1,000 A X PERSONAL & ADV INJURY I 1,000,000 GENERAL AGGREGATE I 1,000,000 ~.~ AGG~EnE LIMIT APr~.~t PER PRODUCTS - COMP/OP AGG I Included POLICY j~8i LOC ~TOMOBILE LIABILITY \,O~~ COMBINED SINGLE LIMIT I ANY AUTO (Eaaccidenl) - -~ ALL OWNED AUTOS \0 BODILY INJURY 1">'3 I SCHEDULED AUTOS (Per person) - '(\) J Ii: / ~/ - HIRED AUTOS " ' BODILY INJURY - 1>,:r\'\~U '_1 . I NON-O\fv1\JED AUTOS 1// (PeraCCldanl) f- I)LI0(~ .,1._ .- 6, ...{ ':-J\\-:','''' , 1- -- '"?/'AI---~ , \ > t\\e':i PROPERTY DAMAGE I ?' \'0.';') '.,."1 1\.\.\0 (Per accident) ROE LIABILITY ------ . v. .t'S0.\ AUTO ONLY - EA ACCIDENT I f',.SS\":> f=-'--'-- ANY AUTO OT HER THAN EA ACC I AUTO ONLY AGG I t3ESSlUMBRELI-A LlA.BILITY EACH OCCURRENCE I OCCUR 0 CLAIMS MADE AGGREGATE I . R DEDUCTIBLE I RETENTION I I WORKERS COMPENSATION AND 1818185 2005 02/12/2005 02/12/2006 X I VvCSTATU-"I IOJJ;1- EMPLOYERS' L1AB1L1TI 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE E;,L EACH ACCIDENT I OFFICER/MEMBER EXCLUDED? E,L, DISEASE - EA EMPLOYE . 1,000,000 If yes, describe under 1.000,000 SPECIAL PROVISIONS below E L. DISEASE - POLICY LIMIT I OTHER DESCRIP]10N OF ?PERATIONS / LOCATlpNS 1VEf1L.ES I EXCLUSIONSi;DDED BY ENDORSEMENT I SPECI1L PROVISIONS . he Clty 0 Santa Ana ,ts 0 leers, emp oyees, agents, vo unteers & representatlves are dditional insureds as respects General Liability per endt S114 (04.97) ertificate revises and super cedes cert issued 03/21/05. ["ExcePt 10 Day Notice of Cancellation for Non-payment of premium applies. CERTIFICA TE H LDER CANCELLA liON The City of Santa Ana Attn: Dave Urbin 220 S. Daisy Avenue, Bldg A Santa Ana, CA 92703 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ~PlRA TION OATE THEREOF, THE ISSUING INSURER WlllllUX~~ MAIL '* 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT - ItllJlI(ll(X~II~~XX . XXXXXXXX: ACORD25(2001/08) FAX: (714)647-3345 Mi