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. 6. O � CERTIFICATE OF LIABILITY INSURANCEF5/5/2011
<br />DATE(MM/DD/YYYY)
<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 CERTIFIGATE HOLDER. � ~
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the p` iicp(ies) ust 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 endorsement(s):
<br />PRODUCER r-- -.-� -A,
<br />Elizabeth Souther Insurance Group
<br />29395 Agoura Rd
<br />Suite #202
<br />Agoura Hills CA 91301
<br />CONTACT
<br />$e�'nadette Gl n
<br />yn
<br />P�Ne"`-. (866)544-8273 FAX
<br />No): (866)544-3486
<br />ADDRESS:bglynn@elizabethsouther.com
<br />PRODUCER 00000923
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED
<br />PBC Holding Corp, DBA: Pacific Building Care,
<br />3080 Airway Avenue, Ste 101
<br />i2 OD
<br />,Costa Mesa CA 92626
<br />INSURERA:First Mercury Insurance Company 10657
<br />INSURER B:Philade l hia Indemnity Ins Cc 18058
<br />INSURER CNational Union Fire Ins Cc
<br />INSURER DEm to ers Compensation Ins Cc
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:11-12/WC 6 ALL REVISION NUMBER -
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />p
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />X
<br />FMMI024873
<br />3/1/2011
<br />3/1/2012
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $ 50,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL 8 ADV INJURY $ 1,000,000
<br />_
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'LAGGREGATELIMITAPPLIES PER:
<br />PRODUCTS-COMP/OPAGG $ 2,000,000
<br />X POLICY PRO-
<br />JECT LOC
<br />$
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />B
<br />ALL OWNED AUTOS
<br />PHPK695636
<br />3/1/2011
<br />3/1/2012
<br />BODILY INJURY (Per accident) $
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident) $
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />A PPRO V iA
<br />:. t) S
<br />1
<br />-0 t_ ,a:' -
<br />! v
<br />l\4
<br />Terrorism $
<br />Uninsured motorist BI -single $ 1,000,000
<br />_
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />...._.-,
<br />j�dUl'�i St;il SI
<br />AsS1Sld..iJ_,: (�I(,y AltorileL
<br />� 0/
<br />CeCIV
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $
<br />DEDUCTIBLE
<br />$
<br />C
<br />X
<br />RETENTION $ 10,000
<br />48251200
<br />10/5/2010
<br />10/5/2011
<br />$
<br />D
<br />WORKERS COMPENSATIONWC
<br />ANDEMPLOYERS' LIABILITY Y/ N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH) ❑
<br />If yes, describe under
<br />Dns,OF OPERATIONS below
<br />NIA A
<br />IG1332359-0
<br />05/04/11
<br />05/04/12
<br />STATU- OTH-
<br />X T MIT R
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 11000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />The Certificate Holder is named as Additional Insured, but only as respects General Liability arising out of the
<br />operations of the Named Insured per the attached endorsement.
<br />aflexen@pbcare.com
<br />The Depot at Santa Ana
<br />Attn: Christy Kindig
<br />1000 E. Santa Ana Blvd.
<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 />AUTHORIZED REPRESENTATIVE
<br />Monteith/BGL �j--- P—� C—
<br />M. Wrxw &u k4ulivruv) U 1933-2009 ACORD CORPORATION. All rights reserved.
<br />INS025 (200909) The ACORD name and logo are registered marks of ACORD
<br />
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