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Accwho' CERTIFICATE OF LIABILITY INSURANCE <br /> <br />DATE (MMIDD[YYYY) <br />1 2/20/2013 <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 Edgewood Partners Insurance Center (EPIC) CONTACT NAME: <br /> <br />19000 MacArthur Blvd. PH Floor _ ii <br /> <br />Irvine, CA 92612 PHONE_A/C No Exty (949) 263-0606 _ `_FAXiA/C,_Not: (949) 263-0906 <br /> E-MAIL ADDRESS: <br /> INSURER(S) AFFORDING COVERAGE NAIC # <br />www.edgewoodins.com -- - - - -- - INSURER A_ Lexington _Ins. Co. 19437 <br />INSURED <br />Sierra Pacific Electrical Contracting INSURER B: . Golden Eagle Ins. Corp. 10836 <br />- <br />2542 Avalon Street INSURER C : RSUI Indemnity Company-_-_ - 22314 <br />Riverside CA 92509 INSURER D:_ Benchmark Ins._Co._ _ 41394 <br /> INSURER .E:_ Peerless Ins. .Co._--.---____-. _ 24198 <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 15547974 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 - ----- IADDL SUM <br />POLICY EFF i POLICY EXP <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDD/YYYY <br />- -------_-- <br />LIMITS <br /> <br />GENERAL LIABILITY <br />A 023462673 6/30/2012 16/30/2013 EACH OCCURRENCE $ 1,000,000 <br /> <br />COMMERCIAL <br />GENERAL LIABILITY <br />- ,000,OOO Per <br /> <br />$S DAMAGE TO RENTED ,000 <br /> <br />--- -- $ ------ <br />PREMISES (Ea occurrence) SO <br /> <br />Project Agg/Limit -- <br />CLAIMS-MADE <br />OCCUR <br />_ <br />?_ <br />Contractual Liability MED EXP (Any one person) $ Excluded <br /> <br />? Wrap Exclusion <br />ncluded <br /> <br />$ 1,000,000 <br />_V INJURY <br />PERSONAL & AD <br />-000 <br /> <br />UCt• <br />2 OOO,OOO <br />GENERAL AGGREGATE $ <br />+ - - -- <br /> <br />- <br />GEN'L AG <br />GREGATE LIMIT APPLIES PER: <br />- <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />1 <br />POLICY PRO- I LOC i <br />$ <br />ABILITY <br />B <br />I <br />T <br />O BA8161433 6/30/2012 6/30/2013 (Ea acct dentswGLE LIMIT $ 1,000,000 <br />A <br />UTO <br />? <br />o N <br />BODILY INJURY <br />(Per person) $ <br /> <br />ALL OWNED SCHEDULED' <br />_ <br />_ AUTOS I AUTOS <br />l <br />1 <br />- --- <br />BODILY INJURY <br />accident <br />(Per ) ! $ <br /> <br /> <br />' <br />? HIRED AUTOS NON-OWNED <br />?AUTOS <br />PROPERTY <br />DAMAGE <br />( $ <br />(Per accident <br /> T`QS? r+? = ^ y ,.? y t.,i E 3 R'a. a4'vI <br />JC S <br />_ <br /> _ t- <br /> $ <br />C UMBRELLA LIAR OCCUR <br />I <br />? 1 NHA230771 6/30/2012. <br />6/30/2013 <br />EACH OCCURRENCE . $ 2,000,000 <br />_ <br />EXCESS LIAB CLAIMS-MADE <br />_ <br />- <br />AGGREGATE $ 2 <br />000 <br />000 <br />7 L3 L , <br />, <br />, <br />- - <br />RETENTION $ <br />T <br /> <br />$y -- - - <br />t <br /> $ <br /> $ <br />D WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY CST5003428 ''. 1/1/2013 1/1/2014 WCSTATU- OJH <br />TORY LIMITS tR <br /> <br /> <br />i YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> <br />OFFICER/M <br />EMBER EXCLUDED? <br />? <br />OFFICER/M <br />MB <br />N/A <br /> <br />,, i <br /> <br />E L EACH ACCIDENT <br /> <br />$ 1 00-000 <br /> ry ) I E L. DISEASE EA EMPLOYEE $ 1 000 0000 <br /> <br />y <br />under <br />- - <br />- <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />E Business Personal Property CBP8917155 6/30/2012 1 6/30/2013 $267,000 Limit $1,000 deductible <br /> Special Form-Replacement Cost <br />Leased/Rented E i $90,000 Limit $1.000 deductible <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Project# 12-056 - City wide LED cobrahead street light replacement. <br />Certificate holder is additional insured for general liability as required by written contract with the named <br />insured prior to an occurrence as per form 11-85 subject to all policy terms & conditions. <br />GL Waiver of Subro LEXOCC234 1103 & Proj Agg LX9695 & Primary Wording LX98380805 will apply if required by written contract. <br />Work Con to of Subro WC040306 & auto liability add'I ins GECA 701 a I if re uired b written contract. <br />CERTIFICATE HOLDER CANCELLATION <br />Project# 12-056 - City wide LED cobrahead street light replacement <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />its officers, employees, agents, volunteers ACCORDANCE WITH THE POLICY PROVISIONS. <br />and representatives <br />20 Civic Center Plaza - Ross Annex (M- 2 2) AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92701 <br /> Susan J. Sampson <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />CERT NO.: 15547974 Lupe Oit_z 2/2C/2C13 1:56:17 PM Page 1 of 9