COMMERCIAL CLEANING SYSTEMS (FORMERLY PACIFIC BUILDING CARE, INC.) 4C - 2012

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ACOR©P CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS �••�'� 10/31/2012 9/28/2012 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 certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 Lockton Companies, LLC Denver 8110 E. Union Avenue Suite 700 Denver CO 80237 CONTACT PHONE FAX No. Ext): A/C No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: Starr Indemnit & LiabilityCompany 38318 N INSURED pacific Building Care, Inc. 1345173 INSURER B: 42587 INSURER C: St. Paul Surplus Lines Insurance C-ompany 30481 dba Commercial Cleaning Systems 1375 Sunflower Avenue, #200 Costa Mesa, CA 92626 INSURER D: Travelers Casualty and Surety Co of America 31194 INSURER E: INSURER F: COVERAGES PBCHOuu 23724GEHTIFIGATE NUMBER: 12000961 REVISION NURARFD• XSIXiiYYy THIS IS TO CERTIFY THAT THE POLICIES 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD INSR SUBR WVD POLICY NUMBER MM% ID/YYVY PLICY EXP MM/DD1YYYY LIMITS A GENERAL LIABILITY Y N SISIGCS06001212 10/1/2012 10/1/2013 EACH OCCURRENCE $ 900-000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 0 X MMERCIAL GENERAL -LIABILITY CLAIMS -MADE I X OCCUR MED EXP (Any oneperson) X $100,000 SIR PERSONAL 8 ADV INJURY $ 900,000 GENERAL AGGREGATE $ 1 -900,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG I ,900,000 PRO - X POLICY F JECT LOC $ B AUTOMOBILE LIABILITY N N ACP7505806934 10/1/2012 10/1/2013 COMBINED SINGLE LIMIr— (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ XXXX xX3 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident XXJ X PROPERTY DAMAGE $ XXXXXXX NON -OWNED HIRED AUTOS $XXXXXXX C X UMBRELLA LIAB X OCCUR N N QZ08300059 10/31/2011 10/31/2012 EACH OCCURRENCE $ 51000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 5.000,000 DED I X I RETENTION $ $0 $ X A WORKERS COMPENSATION N _ _ AND EMPLOYERS' LIABILITY Y/N 1000001054 10/1/2012 10/1/2013 X ORYLIMIT JOTH ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED. N / A E.L. EACH ACCIDENT $ 1.000,000 andatoif yes, describeIn tunderE.L. DISEASE - EA EMPLOYE $ 1 000 000 E.L. DISEASE - POLICY LIMIT $ 1!000!0 0 DESCRIPTION OF OPERATIONS below D Employee Theft incl. N N 105738933 10/1/2012 5/1/2013 $ 1,000,000 Limit Employ. Theft of Client $25,000 Deductible Prop. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ** Refer to Attached ** Refer to Attachment 481128 .APPROVED AS TO FORM rE HOLDER Assistant /City Attorney 12000961 City of Santa Ana c/o Public Works Agency/SARTC 20 Civic Center Plaza, M-21 Santa Ana, CA 92701 See SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The ACORD name and logo are registered marks of ACORD r% �� 2010 ACORD CORPe