SANTA FE BUILDING MAINTENANCE SERVICES 1 - 2014

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Policy Number: Date Entered: 1/8/2009 CERTIFICATE OF LIABILITY INSURANCE 7/31/2014Y) 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 VICTORIA INSURANCE AGENCY Chris D. Victoria 1740 West Katella Ave #H CONTACT NAME: CHRIS VICTORIA PHONE .(714)744 -4500 FAX Net; (714)744 -2500 E-MAIL VICTORIAINSURANCE345 @GMAIL.COM ADDRESS: GENERAL LIABILITY Senior Assistant City Atti Orange, CA, 92867 N I NSURER A: TRUCK INSURANCE EXCHANGE 21709 217009 9 INSURED SANTA FE BUILDING MAINTENANCE INSURER B: MID- CENTURY INSURANCE COMPANY 21687 INSURER C: GUADALUPE MEDINA INSURER D: /29/2015 15644 PALOMINO DRIVE CHINO HILLS, CA 91709 -5510 INSURER E: $ 5,000 INSURER F $1,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ADOL INSR SUBB WVD POLICY NUMBER POLICY EFF MM /DDNYV POLICY EXP MWDDNYYY LIMITS GENERAL LIABILITY Senior Assistant City Atti orney EACH OCCURRENCE $1,000,000 A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE (OCCUR 60366 -65 -69 3/29/2019 /29/2015 PREMIETORENTEO PREMISES (Ea occurrence $ 75,000 VIED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP All $1,000,000 IX POLICY PE OT n LOG I I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 60486 -94 -07 01/01/2019 1/01/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B NON -OWNED HIRED AUTOS AUTOS $ A UMBRELLA LIAB OCCUR EACH OCCURRENCE $2,000,000 AGGREGATE $ CLAIMS -MADE 60499 -63 -93 03/29/2014 3/29/2015 CXCESSLIAB ED RETENTION $ 10, 000 1 1 $ 1 WORKERS COMPENSATION TWO STATU- OTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNEWEXECUTIVE V/N OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A A0931 -60 -49 12/15/2013 2/15/2019 E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE EA EMPLOYEE $2,000,000 If yyes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 2, 000, 000 A EMPLOYEE DISHONESTY 60366 -65 -69 3/29/2014 /29/2015 $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 30 DAYS NOTICE OF CANCELLATION EXCEPT FOR NON PAYMENT OF PREMIUM WHICH REMAINS AT 10 DAYS THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE ADDITIONAL INSURED IN RESPECT TO GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION THE CITY OF SANTA ANA APPROVED AS TO FORM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 60 CIVIC CENTER PLAZA P.O. BOX 1981 �� A -, P(� J�J� °'ACCORDANCE THE EXPIRATION DATE THEREOF, NOTICE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN SANTA ANA, CA 92702 Laura A. Rossini AUTHORIZED REPRESENTATIVE Senior Assistant City Atti orney HRIS VICTORIA ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced Jong Forms Bass Plus software. www.FormsBoss.com; Impressive Publishing 800- 208 -1977