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TSJELEC -01 JMCNAMARA
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMIGlNDb YYYYi
<br />^ERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T'riE TERMS„
<br />1011912015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 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 doses not confer rights to the
<br />certificate holder In lieu of such ondorsement(s).
<br />—�
<br />PRODUCER License # 0757776
<br />CONTACT Kristie Koehrer
<br />Riverside, - International Insurance ervlcesInc,
<br />R. O. Box 534"a
<br />34
<br />—�. _
<br />PI
<br />� IONE 951 788 8500 FAx
<br />� rC a Earl, ( ) _ �_IArC, NeJ: 788 -8502
<br />Riverside, 92517
<br />w�951)
<br />E-MAIL Cal.CPU@Hubinternational.com
<br />ra Flubintsrnat onal,com
<br />_
<br />INSURER(S) AFFORDING COVERAGE ....m. NAIL #..,
<br />_
<br />EACH OLCURRE NCE
<br />m
<br />INSURERA,OhIrJ Security Insurance Company 24082
<br />INSURED
<br />- _._.
<br />INSURER , 91VIest. American Insurance Co
<br />I9
<br />......_,.
<br />44393
<br />TSJ Electrical & Communications Inc, dba Masters Electric
<br />INSURER c. American Fire and Casua - CYcmpan .
<br />24068..
<br />INSURER D : State Compensation Insurance Fund of California
<br />36076
<br />7490 Jurupa Avenue
<br />Riverside, CA 92504
<br />X I PD Dad $2,000
<br />INSURER E;
<br />INSURER F ;
<br />15 „000
<br />COVERAGES CERTIFICATE NUMBER: FrI ISICSN NIIMIRI=P-
<br />THIIS 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 OR ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />^ERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T'riE TERMS„
<br />EXCLUSION'S AND CONDITIONS OF SUCH PCUCIIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />..... .�.� _,_._ -."
<br />INSR
<br />LTR
<br />INSURANCE
<br />TYPE OF INSURANCE
<br />Q
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />70L2T, Ef=F
<br />M'�wfDfllYi'Y'!
<br />POLICY EXP'
<br />MM11}DJHYYY
<br />......... ......... . .....,...
<br />LIMITS
<br />A
<br />X COMIIMERCIALGENERALLIABILITY
<br />.,
<br />_
<br />EACH OLCURRE NCE
<br />; $ 11000,000
<br />��-y�
<br />CLAIMS -MADE IT OCCUR
<br />X
<br />BKS56073610
<br />� 0412012015
<br />0412012016
<br />EIJTE.
<br />LA"AAOESIEaccaurrence
<br />$ 500,000
<br />X I PD Dad $2,000
<br />MEAD E4P (Any �n ®per anI
<br />15 „000
<br />.... .........
<br />PERSONAL &AVV INJURY
<br />1,000,..000
<br />mm,
<br />GENERAL AGGREGATE
<br />,$
<br />$ 2,000,000
<br />GEN"L AGGREGATE LIMIT APPLIES PER
<br />] JECT [1
<br />--
<br />POLICY , L{7C
<br />PRODUCT$- OOMIPr'CPAGG
<br />$ 2,000,000
<br />OTHER
<br />S
<br />AUTOMOBILE LIABILITY
<br />I''
<br />COMBINED SINGLE ILIMJ
<br />lEa acUde nt)
<br />$ 1,000,000
<br />ANY AUTO
<br />BAWS6073610
<br />0412012016
<br />04120120116
<br />03ODILv INJURY (Per pe aon)
<br />$
<br />ALL CUUPJED SCl IEDULED
<br />AU7C5 .. !AUTOS
<br />NOWO"NED
<br />I
<br />I
<br />BODILY INJURY Per ac�Adenl;
<br />I
<br />,y
<br />X HIRED AUTOS ,AUTOS
<br />Y
<br />PROPFRTI DAMAGE
<br />PerenelQ'
<br />I $
<br />I
<br />p UMBRELLALIAS X
<br />OCCUR
<br />....... ..
<br />EACH
<br />5,000,000
<br />C
<br />X
<br />EXCESS
<br />I -
<br />CLAIMS MADE.......
<br />ESA56073610
<br />04/2012015
<br />0412pJ2016
<br />�
<br />AGGREGATE
<br />..m__. ..
<br />$ �a,0a0,0a0
<br />BED RETENTIION$
<br />........
<br />WORKERS COMPENSA71ON
<br />STATUTE
<br />AND EMPLOYERS' LIABILITY Y
<br />�
<br />fi ._
<br />D
<br />ANFIPROP tETO ARTNDLD7
<br />PXCLUD lE E "CIrTIwE
<br />=
<br />iQY'Y4'
<br />50761462015
<br />1011812015
<br />Y
<br />1 011 812016
<br />FI EAGH�,CCIDENT
<br />ID
<br />$ 1 000,00 0
<br />-
<br />(M ICE ry In NR
<br />w
<br />E.L. DISEASE - EMa I
<br />P O', EE
<br />-
<br />—
<br />$ 1,000,0o0
<br />VI yyes, describe under'
<br />E L. DISEASE- POLICY WIT 9
<br />--
<br />$ 1,000,000
<br />DESCRIPTIC7N OF DPCI'tATIi7I3S beBcrw
<br />-
<br />I
<br />I
<br />...,_. ......
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add Moral Remarks Schedule, may be attached If mare apace Is required]
<br />The City of Santa Ana is Additional Insured in regards to the General Liability policy per attached form CG881 0 04113.
<br />1 "1 q 7 ED B �rlwgq l CE q iL q q:VDq (PG lil ,
<br />..
<br />The Depot at Santa Ana
<br />1000 E. Santa Ana Blvd., Suite 108
<br />Santa Ana, CA 92701
<br />L- 3 -17101*1q-1I1 Tt1
<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 />AUTHORI7En REPRESPNTATIVE
<br />C0 1958 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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