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ACcaRDr, CERTIFICATE LIABILITY INSURANCE
<br />DATE(MWDDIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM'S,
<br />5/22/2015
<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(les) 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 endorsements y
<br />PRODUCER
<br />lays___
<br />MHBT Inc,
<br />8144 Walnut Hill Lane, 16th PI
<br />.._-...... FA.. .....
<br />Q-_ �gvc NNo}N,9_7 376_-6194
<br />A
<br />Dallas TX 75231
<br />MA"1168-
<br />ADDREss:'llCly� aysCcar�l$ tom
<br />PP2'EM SETO R TFID
<br />g rice
<br />INSURER (Sl AFFORDING COVERAGE
<br />NAIC p
<br />-
<br />INSUREI!_g T\Nir. Ciiy Ie IEIS.0 rp Cc.
<br />INSURED
<br />HUITTZO,L
<br />NSUREIz B
<br />_._. Hartfo.rd a-svoit. _Insgrance eta.
<br />Huitt-Zoilars', Inc.
<br />INSURER C:
<br />1717 McKinney inney Ave., Ste, 1400
<br />MED EXP (Any one person)
<br />Dallas TX 75202-1236
<br />INSURER D -.........._— __
<br />__
<br />INSURER E
<br />PERSONAL & ADV INJURY
<br />INSURER r
<br />COVERAGES CERTIFICATE NUMBER:844620416) 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 />INDICATFD NOTWITHSTANDING ANY REOOIREMFNT, 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 TERM'S,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY' HAVE BEEN REDUCED BY PAID CLAIMS,
<br />TRW-- _....,__ADflt.SUf3R... ...POLICY EEE POLrCYEXp..... -. _._._._..._,..__ . ..........
<br />LTR TYPE OF INSURANCE INS"1MVD POLICY NUMBER MMIDDPYYYY MM DDPYYYY LIMITS
<br />A
<br />GENERAL LIABILITY
<br />—.
<br />46UUNL.13272 'S 11/2015
<br />3/112016
<br />LACH.00Ci1RRENCE ..-.�
<br />41„p00.000
<br />X COMMERCIAL GENERAL. LIABILITYO777
<br />PP2'EM SETO R TFID
<br />g rice
<br />,.._...._--__..m
<br />X1,.000,000
<br />CLAIMS -MADE OC'
<br />MED EXP (Any one person)
<br />$10 000
<br />_.,_....
<br />PERSONAL & ADV INJURY
<br />51,000,000
<br />........._ --- .............
<br />GENERAL AGGREGATE.
<br />82,000000
<br />GEN'L AGGREGATE LbMPT APPLIES PER i
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />POLICYx PE LOC
<br />E3
<br />AUTOMOBILE LIABILITY
<br />46UENPBO920 6/1/2015
<br />5/112ai6
<br />Fa ac¢identl._..., ..
<br />1, {100,000
<br />x ANY AUTO
<br />'..,
<br />..._,_._
<br />BODILY INJURY (Per person)
<br />g _. ...-`
<br />ALL OWNED SCHEO'ILFO
<br />AUTOS AUTOS
<br />',,
<br />BODILY INJURY Per accidenrl
<br />i
<br />S
<br />NDId-OVkPNd=tb
<br />._ HIRED AUTOS 'Y` AUTOS
<br />_-... DAM
<br />PraCgjqPROPERTY DAMAGE
<br />r acc#dernl'1
<br />.. _....,_,.
<br />$
<br />5
<br />A
<br />X UMBRELLA LIAR
<br />X
<br />OCCUR
<br />46XHURJ8271 G1112015
<br />/111016
<br />EACH OCCURRENCE
<br />$2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE_
<br />.!.
<br />AGGREGATE
<br />$2.000.pp0
<br />OLO X RETENTION $10,000
<br />S
<br />A
<br />WORKERS COMPENSATION
<br />46WEZU9 69 61112015
<br />3/112015
<br />X WC S IATU I OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOfVPARTNERFEXECLtlTIVF
<br />OFF ICER/MEMBER EXCLUDED? �
<br />N/A
<br />E.L. LACI I ACCIpPN T
<br />._.._. ....__�_._..,�
<br />$1,000000..,....._
<br />(Mandatory in NH)
<br />E.L. DISEASE -EA EMPLOYE.
<br />51,000,000
<br />V yes, describe ander
<br />I
<br />DESCRIPTION OF OPERATIONS below,
<br />E DISEASE.. -POLICY LIMIT
<br />$1.000,000
<br />I
<br />I
<br />DESCRIPTION OF OPERATIONS 1LOCATIONS I VEHNCLES (Attach ACORD 141„ Ad(861Pana@ Remarks Schedule, If more space is required)
<br />Additional Insured and Primary & Non -Contributor/ Ianguage is in farm #HGO01 edition 06/05 of the General Liability policy,
<br />Additional Insured and Primary & Non -Contributory language is in fore-HA9916 iitio 03/12 of the ALito Liability policy.
<br />HUITT-ZOLLARS, INC A-2011-247 REVIEWED BY6-,� Al ep- EUNICE HEREDIA, (PG 1 OF 20)
<br />Certificate Holder, and any entity required by written Contract, is named as an Additional Insured per the above form(s) including Primary and
<br />Non Contributory status but only to the extent that the limits and forms are required to satisfy the terms of a Written contract.
<br />See Attached...
<br />-1 � „ uu I E.. 1 mvr...w,r 11 k fM INUGL. LHt IUIX
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Public Works Agency M-22'.
<br />P.O. Box 1988 AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702 9�
<br />d
<br />(d) 1988,-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (20-10/05) The ACORD name and logo are registered marks of ACORD
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