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4 Client#: 1259431 305CORDOCOR
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />`)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />7TE
<br />1/2011
<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 CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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
<br />CONTACT NAME: Christy Mata
<br />BB&T Insurance Services
<br />PHONE 714 578-7370 FAX
<br />of Orange County
<br />(A/C,
<br />/C No Ext : A/C, No):
<br />n DRIESS: CMata@BBandT.com
<br />680 Langsdorf Drive Suite 100
<br />EACH OCCURRENCE $1,000,000
<br />Fullerton, CA 92831
<br />CUSTOMER ID M
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: Hartford Casualty Insurance Com 29424
<br />Cordoba Corporation
<br />INSURER B: Everest National Insurance Co 10120
<br />1401 N. Broadway
<br />INSURER C: Property & Casualty Ins Co of H 34690
<br />Los Angeles, CA 90012
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />GENERAL AGGREGATE $2,000,000
<br />COVERAGES CERTIFICATE NUMBER: 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 />DOL
<br />N R
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDNYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />72SBACP3130
<br />1/20/2011
<br />01/20/2012
<br />EACH OCCURRENCE $1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE IF7AV1 OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $300,000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL & ADV INJURY $1,000,000
<br />GENERAL AGGREGATE $2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />X POLICY PRO-
<br />jECT F7 LOC
<br />$
<br />C
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />72UECUS9769
<br />1/20/2011
<br />01/2012012
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $1,000,000 000 000
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident) $
<br />X
<br />NON-OWNEDAUTOS
<br />$
<br />A
<br />UMBRELLA LIABX
<br />OCCUR
<br />72SBACP3130
<br />1/20/2011
<br />01/20/201
<br />EACH OCCURRENCE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $5,000,000
<br />DEDUCTIBLE
<br />X
<br />RETENTION $ 10000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? FN]N/A
<br />CA20011117111
<br />1/20/2011
<br />01/20/201
<br />OTH-
<br />X TORY
<br />!S FR
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT .0000.00y0
<br />DESCRIPTION OF OPERATIONS below
<br />7
<br />� t-$1
<br />X 12 �._.t ;/ T.: i_ i'�1,"Y o FORM
<br />OR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />Per form SS0008 04/05 pages 11-13 of 24 attached, the following are named as Additional Insureds, as �1
<br />respects to General Liability, as required by written contract.._ jtl�°�'r�e
<br />(See Attached Descriptions) ::: i ; .5. ; t t eedy
<br />City of Santa Ana
<br />Transportation & Traffic Engineer Public
<br />Works Agency M-93
<br />Attn: David Biondolillo; 20 Civic Center Plaza
<br />ACORD 25 (2009/09) 1 of 2
<br />#S6218762/M6217385
<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 />A)ZA
<br />m 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />LXMCN
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