PACIFIC SYSTEMS ELECTRIC 2A - 2009

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�CORa� CERTIFICATE OF LIABILITY INSURANCE 4'P ID Jl DATE(MMlDD/ � 10/13/1/1 0 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 certif tate holder Is an ADDITIONAL INSURED, the policy(les) must 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 endorsement(s). PRODUCER NAME: PHONE (A1C, No, Ext): (A C, No): Roger Stone Insurance Agency ADDRESS: 5015 Birch Street Newport Beach CA 92660 CUSTOMERID#: PACI-12 Phone:949-757-0270 Fax:949-757-0375 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Scottsdale Ins. Co. Pacific Systems Electric, Inc. 32670 Dowling Court INSURER B: Mercury Casualty Co 11908 INSURER C Winchester CA 92596 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLCIES 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 CONDI—IONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBERLIMITS (MMIDDM'YY) {MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPS1111583 02/02/10 02/02/11 PREM ISES(Ea occurrence) $50,000 CLAIMS -MADE A OCCUR MED EXP (Any one person) $ 5,000 X Owner/Cont Prot.— X PERSONAL & ACV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APP'_IES PER PRODUCTS- COMP/OP AGG s2,000,000 POLICY X ,ECT LOC Emp Ben. $ None AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 B X ANY AUTO CCA0006663 02/01/10 02/01/11 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS 'PROPERTY DAMAGE ' HIRED AUTOS$ (Per accident) F NON -OWNED AUTOS $ 1 $ A UMBRELLALIAB OCCUR XBS0006443 02/02/10 02/02/11 EACH OCCURRENCE s4,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $4,000,000 DEDUCTIBLE X RETENTION $ N/A $ WORK S COMPENSA ION AL ii t7 t �,/ ' L`-" �� OTH AND EMPLOYERS' LIABILITY Y f N e •�� •-, _ TORY LIMITS ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? /A EL EACH ACCIDENT $ (Mandatory in NH) f e u yes, describnder E.'L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below --. -- EL DISEASE- POLICY LIMIT $ a ilio , Attorney DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) RE: Electrical services for the City of Santa Ana CA. The City of Santa Ana its officers, employees, agents and representatives are named Additional insured with primary and non-contributory per form CG20100704 attached. *10 day notice of cancellation for non-payment of premium. CER I iFiCA I E HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYSA9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. XXXXXXXXXXXX Attn: Building Maintenance Div P.O. Box 1988 AUTHORIZED REPRESENTATIVE 20 Civic Center Drive Santa Ana CA 92702 © 1988-2009 ACORD CORPORATION. All rights ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD