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ACOOR" CERTIFICATE OF LIABILITY INSURANCE ATE D08/29/2017 ) 08/29/2017 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 have ADDITIONAL INSURED provisions or 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 CS&S/STONEBROOK INSURANCE SRVCS INC CONTACT NAME: PHONE FAX (A/C, No, Ext): (q/Q No): PO BOX 946580 MAITLAND, FL 32794-6580 E-MAIL Phone - 877-724-2669 ADDRESS: Fax - 877-763-5122 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American Casualty Company of Reading, Pennsylvania 20427 INSURED SLOAN VAZQUEZ INC INSURER B: 3002 DOW AVE STE 116 INSURER C INSURER D: TUSTIN, CA 92780-7247 INSURER E: INSURER F: GUVtKAGtS GtKIII-I :AIt NUIM1=11: 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 ADDL lNSD SUBR WVD POLICY NUMBER POL Y MM/DD/YYYY POLICY XP MM/DDIYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE [—] OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ LOC JECT GENERAL AGGREGATE PRODUCTS - COMP/OP AGG OTHER COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY (Per person) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR DED I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT 1'000'000 A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N/A N 5085258125 07/10/2017 07/10/2018 E.L. DISEASE • EA EMPLOYEE 1'000'000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance &I VIFVt1C7 �3Y': -_ _F_.tkhIICL 6 9Ef0 CTIA (PG OF } CERTIFICATE HOLDER CANCFI I ATICIN CITY OF SANTA ANA -Santa Ana Public Works Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana„ CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD cac7980