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FEB 20. 2015 9,10AM <br />9492168855 <br />NO 2993 P. 2/21 <br />SOUTH -5 OP ID: SF <br />AR °` CERTIFICATE OF LIABILITY INSURANCE <br />DA,B(MMmDYYYY) <br />02118115 <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 YHE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THI= CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION Is WAIVED, subject to <br />the tormS and conditions of the pollcy, certain pollcles may roqulre an endorsement A statemonl on this certificate does not confer rights to the <br />certificate holderin Ileu ofstl andorsemant(s). <br />PRODUCER <br />Solomon & Solomon Ins Brokers 949563 -0300 <br />Lic 40039562 949-951-0342 <br />2h332 Mp( Creek Or She 135 <br />C una Hills, CA 92653 <br />Ka by Shoffeld <br />CONTACT <br />NAME, <br />fpA C Na E : NNo <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC 0 <br />NSURERA: Hartford Insurance Co. <br />22357 <br />INSURED South Coast Lighting& <br />Design, Inc. <br />1391 CalleAvanzado <br />San Clemente, CA 92673 <br />A9 <br />T r � � ®1 " ✓�Z <br />INSURERS ;OakRiVerins9ranceCompany <br />34630 <br />INSURER C: <br />EACH OCCURRENCE <br />INSURER D: <br />pgaMls•s ccfurron� ca <br />INSURER E: <br />MED EXP(Anyone person) <br />INSURER F: <br />PERSONAL &ADV INJURY <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBRR. <br />THIS IS TO CERTIFYTHAY 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 CON DrrION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />11,31, <br />LTR <br />TYPE OF INSURANCE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />POLICY NUMBER <br />MMIOO <br />MMMDNYYy <br />LIMrTS <br />A <br />GENERALLIABILITY <br />X COMMEROAIGENERALUAIEUTY <br />CLAIMS.MADE XOOCCUR <br />X <br />X <br />72SBAAH4279 <br />11/14/14 <br />11/14/15 <br />EACH OCCURRENCE <br />S 1,000,00 <br />pgaMls•s ccfurron� ca <br />S 9,000,00 <br />MED EXP(Anyone person) <br />S 10,00 <br />PERSONAL &ADV INJURY <br />s 1,000,00 <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE <br />X POLICY <br />LIMIT APPLIES PER: <br />PRO. LOC <br />PRODUCT$- COMPIOP AGG <br />T 2,000,00 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL AUTOS OWNED AUTOSU�O <br />X <br />X HIRED AUTOS )( NON.Oh'NED <br />AUTOS <br />72UECJH2698 <br />03/23/14 <br />0323/15 <br />(Es OINED 51NOLE LIMIT <br />1,000,00 <br />BODILY INJURY (Poe pvo6) <br />1 <br />BODILY INJURY (Per enddent) <br />P <br />AMAGE <br />Perocolden[ <br />S <br />a <br />UMBRELLA LIAIS <br />EXCESS LAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />5 <br />AGGREGATE <br />E <br />ICED I I RETENTION$ <br />$ <br />B <br />woMERs COMPENSATION <br />Am EMPLOYERS' LIABILITY <br />ANY PROPRIErORFARTNER [EYECUAVE YIN <br />OFFICERMIEMBER EXCLUDED? <br />(Mandemry In NH) <br />DESCRIPTION Un OPERATIONS below <br />N 1 A <br />200062195141 <br />00103(14 <br />08103115 <br />X w IAI U. oIH• <br />E. L. EACH ACCIDENT <br />5 1,000,00 <br />E.L. DISEASE• EA EMPLOYEE <br />S 1,000,00 <br />ELL, DISEASE, POLICY LIMIT <br />I S 1,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I WHCLES (Aaach ACORD 101, AddWonPl PumAdfs Schedule, Irmero spgee Is required) <br />City of Santa Ana and hs officers, agents and employees are hereby named „ *R <br />as additional insured per the Business Liability Coverage form, SSKOOS O <br />ladditional insured and waiver of subrogatioh In raga s to general �Ttt5 rt10 F <br />iability pages 15.24)attached to the insureds policy. Waiver of E� F> "' <br />sub rogation apples to workers compensation per blanket form WC99D410AY a OV <br />vnVICInATM U^I nee r- ANICCI I ATInK1 _- icTHP• - <br />CITYSAN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />PO Box 1988 M -21 <br />Santa Ana, cq $2702 <br />AUTHORIZED REPRESENTATIVE <br />��21.n4 _g _ <br />U 1U88 -ZU1U ACUKU CUKPUKAI IUN. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Y <br />RECEIVE: NO.3654 02/20 /2015 /FRI 10:04AM <br />1/Ly <br />