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Ae"Ra CERTIFICATE OF LIABILITY INSURANCE
<br />'..ii
<br />OATE(MMIDDIYYYY)
<br />1 12/29/2015
<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: L1
<br />and certificate
<br />the theholder
<br />p licy, certain Dpolicies Amay require an endorsement. I A statement rondthis ce7r *4}�OOijslbotWAIVEDffb subject to to the
<br />fi±,
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Tolman & Wiker Insurance Services LLC #OE52073
<br />CONTACT Ariana De Leon
<br />NAME: !' °' C a
<br />PHONE (805)585 -6145 I ,r' AIC NO aL5)s8S 6245
<br />196 S. Fir Street
<br />pooaiess: adelson @tolmanandwi .L46m -'
<br />PO Box 1388
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A:Hartford Fire Ins Co
<br />19682
<br />Ventura CA 93002 -1388
<br />INSURED
<br />INSURER B:Hartford Casualty
<br />29424
<br />INSURER C:Hartford Accident & Indemnit
<br />22351
<br />Pacific Coast Cabling, Inc.
<br />INSURER D:
<br />DBA: PCC Network Solutions
<br />INSURER E:
<br />20717 Prairie Street
<br />1 INSURER F:
<br />Chatsworth CA 91311
<br />1111.10LOnAM- Ic1 I .NAg1.9U1d1i111IdiIMA
<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 />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />MMID EXP
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />CLAIMS -MADE OCCUR
<br />DAMAGESi RENTED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />MEO EXP(An one erson)
<br />$ 10,000
<br />72UU 0752
<br />1/1/2016
<br />//1/2017
<br />J(MMhDD[YYYY)
<br />��Cs
<br />OVER
<br />To FO
<br />A
<br />Y1�
<br />lVS'
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER'.
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ PRO-
<br />JECT � LOC
<br />b
<br />G•
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />Employee Benefits
<br />$ 1,000,000
<br />OTHER:
<br />a..
<br />�(
<br />AUTOMOBILE
<br />LIABILITY
<br />L
<br />t C(
<br />Y Attorne
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS WNED
<br />HIRED AUTOS AUTOS
<br />p$$IStan
<br />72UUNSH0752 Y
<br />PO
<br />.l
<br />1/1/2016
<br />1/1/2017
<br />l
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY
<br />Prr cl t
<br />$
<br />Underinsured motorist
<br />$
<br />X
<br />UMBRELLA LAB
<br />X-
<br />OCCUR
<br />,gyp, ^fi
<br />114)
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />F`q1 g,
<br />DED I X I RETENTION$ 10,000
<br />$
<br />72RHUJE1103
<br />1/1/2016 1
<br />1/1/2017
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />OFFICEWMEIMBOER EXCLUDED? ECUTIVE F7
<br />(Mandatory In NH)
<br />NIA
<br />72WEEQ8250
<br />1/1/2016
<br />1/1/2017
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1 100,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />GL: The City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional
<br />Insured as respects to operations of the Named Insured per attached HG0001 0605. This insurance is
<br />primary and non - contributory to any other insurance held by Additional Insured per attached HG0001 0605.
<br />A Waiver of Subrogation is added per attached HG0001 0605. Attached enorsements apply only as required by
<br />written contract during the policy term.
<br />cmarek @santa- ana.org.
<br />City of Santa Ana
<br />Attn: Insurance Services Division M -12
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />Toohey, CISC /ARIAND- `"`��= :r "'""�w
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 nnl4ml
<br />
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