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A� °® CERTIFICATE OF LIABILITY INSURANCE <br />6/5/2014 ' <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 <br />Hatter, Williams & Purdy Insurance <br />2230 Faraday Ave <br />Carlsbad CA 92008 <br />CONTACT Lori Gallegos <br />PHONE (760) 795-2002 FAX Not <br />ADOaless :lgallegos @hwpinsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAIC N <br />INSURERA$'1aXum Specialty Insurance Grp <br />10784 <br />INSURED <br />John Taylor Construction, Inc. <br />1335 Hedionda Avenue <br />Vista C.P. 92 081 <br />INSURER B: <br />email= lgallegosGhwpinsurance.com, c =US <br />INSURER C: <br />Lori Gallegos <br />INSURER D: <br />INSURER E : <br />$ 1,000,000 <br />1 INSURER F: <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />COVERAGES CERTIFICATE NUMBER:14 -15 Master 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 <br />R <br />TYPE OF INSURANCE <br />s <br />R <br />POLICY NUMBER <br />POLICY EFF <br />MMLOOVEXP <br />LIMITS <br />GENERAL LIABILITY <br />email= lgallegosGhwpinsurance.com, c =US <br />Lori Gallegos <br />Date: 2014.07.1814:14:50 - 07'00' <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X <br />DG0064038 <br />4/22/2014 <br />4/22/2015 <br />DAMAGE TO <br />PREMISES Ea occurrence) rr <br />$ 50,000 <br />MED EXP(Any one person) <br />$ 1,000 <br />PERSONAL B ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG <br />$ 1,000,000 <br />X POLICY <br />7 PRO LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />A. <br />doff ■V FOR <br />FOR: <br />SINGLE LIMIT <br />Ea accident <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />�y <br />UMBRELLA LIAB <br />OCCUR <br />R 'O. 1 <br />IODGE <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />to CU3 <br />Attolrney <br />AGGREGATE <br />$ <br />DED I I RETENTION <br />$ <br />WORKERS COMPENSATION <br />TWO STATU S OTH. <br />AND EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICERIMEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory In NH) <br />f yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1 $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />The City of Santa Ana, its officers, employees, agents and representative are named as additional <br />insured. * 30 -Day notice of cancellation for non - payment. Form CG 2010. The draftsman classification <br />applies to employed draftsmen whose duties are strictly limited to office work only. The draftsman <br />classification applies to business establishments operated independently in providing engineering or <br />architect drawing services to others based on specifications provided others only. It also applies to <br />drafts employees by contractors for the purpose of drafting plans for specific jobs. Drafting employees <br />engaged in drafting and confined to office work. <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2010105) <br />I N S025 t9nlnm) n1 <br />© 1988 -2010 ACORD CORPORATION. All rights reserved. <br />Tho Ar.nPn nnma and Innn nra rorni,efarnd marls of ACr1Rn <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, <br />NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Purchasing Department <br />AUTHORIZED REPRESENTATIVE <br />Lori Gallegos <br />Digitally signed by Lori Gallegos <br />DN: cn =Lori Gallegos, o, ou, <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />email= lgallegosGhwpinsurance.com, c =US <br />Lori Gallegos <br />Date: 2014.07.1814:14:50 - 07'00' <br />ACORD 25 (2010105) <br />I N S025 t9nlnm) n1 <br />© 1988 -2010 ACORD CORPORATION. All rights reserved. <br />Tho Ar.nPn nnma and Innn nra rorni,efarnd marls of ACr1Rn <br />