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AC401?a CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />5/24/2016
<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 endorsements .
<br />PRODUCER
<br />INTAC
<br />NAME: _-'Judy Hays _. _. -._.-.
<br />MHBT Inc.
<br />8144 Walnut Hill Lane, 16th FI
<br />PHONE i FAX
<br />-770-1638 fA/C,_Np�972-3.7.6 8194_._ _
<br />EMAIL
<br />ADDRESS:,udy-..ilas c�il� mhIA(nnit� _.._
<br />Dallas TX 75231
<br />INSURERS) AFFORDING COVERAGE NAIC q
<br />i
<br />_INSURERA:j'Wln City Fire,insurance Company–45�....... —
<br />INSURED HUITTZOL
<br />I
<br />INSURERB:Haford ..-89424.,._.--_ -.
<br />Huitt-Zollars, Inc.
<br />INSURERC:
<br />1717 McKinney Ave., Ste. 1400
<br />_
<br />Dallas TX 75202-1236
<br />D INSURER
<br />- _ _._- ------ _
<br />i
<br />X
<br />( POLICY PRO LOC
<br />INSURER E: ............-----
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1747147135 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..... ---- -..._..._.. _. ..._..(ADDLrSUBR . ........__------------
<br />I POLICY EFF POLICY EXP -------------
<br />ITR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/VYYY MMIDDlYYYY I LIMITS
<br />A GENERAL LIABILITY
<br />( 46UUNLJ3272
<br />6/1/2016 ' 6/1/2017
<br />I EACH OCCURRENCE I $1,000,0.00
<br />_
<br />x COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED ..
<br />PREMSESIEeoccurrence) $1 OOO,D00
<br />_ j ( CLAIMS -MADE OCCUR
<br />i
<br />��I
<br />MED EXP (Any one person) $10,000
<br />I
<br />PERSONAL & ADV INJURY _ $1,000,000
<br />{
<br />-
<br />I GENERAL AGGREGATE $2,000,000
<br />S PER:
<br />f GEN'LAGGREGATE LIMIT APPLIES
<br />i
<br />PRODUCTS COMPIOP AG G $2,000,000
<br />i
<br />X
<br />( POLICY PRO LOC
<br />$
<br />B AUTOMOBILE LIABILITY46UENPBO920
<br />I
<br />6/1/2016
<br />11 6/1/2017
<br />UUMUINLU (Ea accident) b .. - -
<br />�1,000,OUO --
<br />f
<br />tX ANY AUTO
<br />- �
<br />�
<br />BODILY INJURY (Per person)
<br />$-
<br />t SCHEDULED
<br />ALL OWNED
<br />(AUTOS AUTOS
<br />IJUIJILY INJURY accitlenp�
<br />$
<br />,
<br />NON OWNED
<br />Ix I HIRED AUTOS x AUTOS
<br />`-
<br />PROERTY AGE
<br />Pea ciUen DAMAGE
<br />I $
<br />($
<br />1
<br />A X
<br />—
<br />UMBRELLA LLABGLAIMS•MADE
<br />OCCUR
<br />46XHURJ(5271
<br />6/1/2016
<br />6/1/2017
<br />EACH OCCURRENCE
<br />j $2,000,000
<br />EXCESS LIAB
<br />I
<br />�—
<br />AGGREGATE
<br />$2,000,000
<br />X
<br />1 DED I RETENTION $10,000
<br />A RKERS
<br />46WEAN7069
<br />6/1/2016
<br />, WC STA 0TH
<br />6/1/2017 X TDRY L MLIS
<br />AND EMPLOYERS' LIABILITY Y / N
<br />DED.
<br />1 Eri
<br />ANY PROPRIETOR/PARTNERfEXECUTIVE
<br />N / A
<br />I E.L. EACH ACCIDENT
<br />$1,000,000
<br />OOCERIMEMBER EXCL
<br />Mandato in NH
<br />( Mandatory )
<br />E.L DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yea, tlescnbe under'
<br />DE5CRIPTION OF OPERATIONS below 1i
<br />E.L. DISEASE - POLICY LIMIT
<br />---
<br />$1,000,000
<br />i
<br />I
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />Additional Insured and Primary & Non -Contributory language is in form #HG001 edition 06/05 of the General Liability policy.
<br />Additional Insured and Primary & Non -Contributory language is in form HA9916 edition 03/12 of the Auto Liability policy.
<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 term f a written contract.
<br />See Attached...
<br />I"ZLWlIEWED BY ELRIIIC t FIERI DIA (PG _0F_ )
<br />CERTIFICATE HOLDER
<br />_._.... ........... _.___.
<br />CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE
<br />„,_..public Works Agency M-22
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />5._
<br />SaTI a Aa M1
<br />AUTHORIZED REPRESENTATIVE
<br />.ryry y qq p„
<br />J U 0 2 0
<br />16L�,
<br />(3"']r O 1988-2010 ACORD CORPORATION, All rights reserved.
<br />AC D 23'i�f0}= The ACORD name and logo are registered marks of ACORD
<br />
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