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aCORD. CERTIFICATE OF LIABILITY INSURANCE GP ID IT DATE (MMIDD/YYYY) <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />PAJC 12 02/19/09 <br />PRODUCER <br />INSHPOLICY <br />LTR NSR <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ISU Insurance Services- <br />DATEFULLY <br />(AIMIDD/YY) <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />The Roger Stone Agency <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />5015 Birch Street <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Newport Beach CA 92660 <br />AIX <br />X COMMERCIAL GENERAL LIABILITY <br />Phone:949-757-0270 Fax:949-757-0375 <br />02/02/091 <br />INSURERS AFFORDING COVERAGE NAIL# <br />INSURED <br />MED EXP An one person <br />Y-- ) 85,()()() <br />INSURER A. Scottsdale Ins. Co. <br />c <br />CL AVIS 1Yi.DE �OCCU: <br />INSURER B Mercury Casualty Co 11908 <br />Pacific Systems Electric, Inc. <br />_ <br />PERSONA-&wV INJURY >1,000,000 <br />INSURER C <br />Charleen 3 Earl Jones <br />32670 Dowling <br />X <br />INSURER D. <br />Winchester CA 92596 <br />rnvcRAGPS <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />INSHPOLICY <br />LTR NSR <br />TYPE OF INSURANCE <br />NUMBER <br />DATEFULLY <br />(AIMIDD/YY) <br />ftx <br />DATE (MMIDDAIV <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $1,00(),000 <br />AIX <br />X COMMERCIAL GENERAL LIABILITY <br />CZS1547446 <br />02/02/091 <br />02/02/10 <br />(Eonce PREMISES 000 <br />MED EXP An one person <br />Y-- ) 85,()()() <br />c <br />CL AVIS 1Yi.DE �OCCU: <br />_ <br />PERSONA-&wV INJURY >1,000,000 <br />X Owner Cont Prot. <br />X <br />Blk't AI, Prim/No <br />GENERAL AGGREGATE $2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />PRODUCTS -COMI AGG $2,000,000 <br />Ben. None <br />POLICY X JECaT LOC <br />B <br />X <br />AUTOMOBILE <br />LIABILITYCOMBINED <br />ANY AUTO <br />AC11063947 <br />02/01/09 <br />02/01/10 <br />SINGLE LIMIT <br />(Ee accident) $1,000,000 <br />BODILY INJURY <br />(Per peneon) $ <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />Per accident) $ <br />X <br />X <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />PROPERTY DAMAGE $ <br />(Par accdern) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />THAN EAACC <br />ANr AUTOOTHER <br />AUTO ONLY AGO $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCUNRENCE $4,000,000 <br />AGGREGATE $4,000,000 <br />A <br />IX <br />X7 OCCUR CLAIMS MADE <br />XBSOOOIS01 <br />02/02/09 <br />02/02/10 <br />a <br />$ <br />DEDUCTIBLE <br />-_ <br />$ <br />X RETENTION $N/A <br />j <br />WORKERS COMPENSATION AND <br />IGFx LIM.TS ER <br />E L. EACH ACCIDENT <br />EMPLOYERS' LIABILITY <br />MY PROPRIETORIPAATN'EEIEXECUTIVE <br />OFFICER,MEMBER EXCLUDED? <br />E. L. DISEASE - EA EMPLOYEE $ <br />Ifyee d..Lbeunber <br />SPECIAL PROVISIONS below <br />E L. DISEASE- POLICY LIMIT $ <br />OTHER <br />PPROVED AS TO FORM <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ,/ <br />RE: Electrical work for the City of Santa Ana CA. �-E-P GLf L <br />Certificate Holder is named Additional Insured with primary and LauratSh e y <br />non-contributory wording per form CG20100704. Assistant ity Attorney <br />*SO day notice of cancellation for non-payment of premium. <br />***Revised - this certificate replaces certificate issued 2/3/09*** <br />CITYSA9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Santa And DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYSWRITTEN <br />Building Maintenance Division NOTICE TO TIRE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />P.O. BOX 1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR <br />20 Civic Center Plaza <br />Santa Ana CA 92702 REPRESENTATIVES. — �— <br />F_116I <br />