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Policy Number:
<br />Date Entered: 1/8/2009
<br />1*. R CERTIFICATE OF LIABILITY INSURANCE
<br />��
<br />12/22/ /2014
<br />12/22/2019
<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 />VICTORIA INSURANCE AGENCY
<br />Chris
<br />Chris D. Victoria
<br />1790 Nest Katella Ave H
<br />#H
<br />CONTACT
<br />NAME: CHRIS VICTORIA
<br />PHONE (714)799 -4500 aC -2500
<br />ADDRE83: VICTORIAINSURANCE345 @GMAIL. COM
<br />GENERAL LIABILITY
<br />AUTHORIZER REPRESENTATIVE
<br />Oran
<br />Orange, CA, 92867
<br />9
<br />INSURERS AFFORDING COVERAGE
<br />INSURER A:TRUCK INSURANCE EXCHANGE
<br />21709 09
<br />INSURED SANTA FE BUILDING MAINTENANCE
<br />INSURER B: MID— CENTURY INSURANCE COMPANY
<br />21687
<br />INSURER C:
<br />GUADALUPE MEDINA
<br />INSURER D:
<br />/29/2015
<br />15644 PALOMINO DRIVE
<br />CHINO HILLS, CA 91709 -5510
<br />INSURER E:
<br />$ 5,000
<br />INSURER F :
<br />$1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 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 />LTR
<br />TYPE OF INSURANCE
<br />ABEL
<br />BR
<br />POLICY NUMBER
<br />MMDDNYYY
<br />MM /DDNYYV
<br />LIMITS
<br />GENERAL LIABILITY
<br />AUTHORIZER REPRESENTATIVE
<br />1
<br />EACH OCCURRENCE
<br />$1,000,000
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE ®OCCUR
<br />X
<br />60366 -65 -69
<br />3/29/2014
<br />/29/2015
<br />PREMISES Ea occurrence)
<br />$ 75,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEHL AGGREGATE
<br />LIMIT APPLIES
<br />PER:
<br />PRODUCTS- COMP /OPAGG
<br />$1,000,000
<br />POLICY
<br />F7
<br />PRO
<br />IFQT 71
<br />LOC
<br />1
<br />1
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COM81N ED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />60486 -94 -07
<br />01/01/2015
<br />1/01/2016
<br />BODILY INJURY (Per accident)
<br />$
<br />B
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$2,000,000
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />60499 -63 -93
<br />03/29/201a
<br />3/29/2015
<br />DED RETENTION $ 10, 000
<br />1
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORPARTNEREXECUTIVE YIN
<br />OFFICER /MEMBER EXCLUDED? r7
<br />(Mandatory in NH)
<br />NIA
<br />A0931 -60 -44
<br />12/15/2014
<br />2/15/2015
<br />WC STATU- OTH-
<br />O L M TS ER
<br />E.L. EACH ACCIDENT
<br />$2,000,000
<br />E.L. DISEASE - EAEMPLOYEE
<br />$2,000,000
<br />If yes, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 2 , 00 0 , 000
<br />A
<br />EMPLOYEE DISHONESTY
<br />60366 -65 -69
<br />/29/2014
<br />/29/2015
<br />$100,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />30 DAYS NOTICE OF CANCELLATION EXCEPT FOR NON PAYMENT OF PREMIUM WHICH REMAINS AT 10 DAYS
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE ADDITIONAL
<br />INSURED IN RESPECT TO GENERAL LIABILITY.
<br />CERTIFICATE HOLDER CANCELLATION
<br />THE CITY
<br />OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />60 CIVIC
<br />CENTER PLAZA
<br />THE EXPIRATION DATE THEREOF, NOTICE
<br />WILL BE DELIVERED IN
<br />P.O. BOX
<br />1981
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92702
<br />AUTHORIZER REPRESENTATIVE
<br />1
<br />��
<br />HRIS VICTORIA
<br />ACO RD 25 (2010/05)
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