|
CERTIFICATE OF LIABILIT1 INSURANCE FlIA15 OVIM101.11yYyy)
<br />5/6/2016
<br />THIS CERTIFICATE IS ISSUED A A MATTER OF INFORMATION ONLY AND G'6NFERS NO 'RIGHTS UPON THE CERTIFICATE HOLDER, THIS
<br />I
<br />ISSUED
<br />CERTIFICATE DOES NOT AFFIR ATIVELY OR NEGATIVELY AMEND, EXTEN1 08 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 />G
<br />REPRESENTATIVE ORPRODUCE , AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate he der Is an AD61t;-- INSURED, the policy(les7' endorsed. If SUBROGATION IS WAIVED, subject to
<br />the Terms and conditions of the P a ,
<br />licy, Certain policies may require an enclorsemet'it A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such a clorsementi3O.
<br />PRODUCER
<br />'1177 OF -K REVISION NUMBER:
<br />SURANCE LIS I Eli BELOW I 1AVE 3H N 3�, LED TO THE INSURED NAMED ABOVE FOR THE TIOLICY —PER75
<br />NO]WITHSTANDING AN
<br />COW ACT '�'77-
<br />NAME V It Salgado
<br />Tolman & Kiker Insurance
<br />ervices LLC #OE52073
<br />EXCI.USONS ANf,,7CO(ql)lr[t)NS OF S
<br />PHONE (805)585-6139 FAX
<br />196 S� Fir Street
<br />ADDL SUER FOUCY EFF POLICY EXP
<br />POLICY _NUMBFR LIMITS
<br />COMMERCIAL GENERAL L M,81L.DY
<br />(A/C,N,E,j,'
<br />E -ML A/C, Nay;
<br />FACH 0CCURRNqCr, $
<br />CI AWSMADI-' OC, ajR
<br />AoDnAIES$: v &,,ilgado@tolmanandwiker . com
<br />PO Box 1388
<br />'Rr'MISF8 (F,%,
<br />WD EXP (A,,yrune
<br />Ventura CA
<br />93002-1388
<br />OF"N'l
<br />INSUREIR(S) AFFORDING COVERAGE MAIC 41
<br />INSURED
<br />U -NERAL A'3rkKGATF $
<br />POL Gly I&C r LUC
<br />INSURER A kV'Terican Eire & Cas ills Co 24066
<br />(rPiFR
<br />INSUR0 8
<br />Roadway Construction Service
<br />CC
<br />INSURER C
<br />12731 Los NiCtos Rd,
<br />NODILY INJURY (Por $
<br />A. OWNFL) SCHMAJU'D
<br />AL901 ALP 6,17,
<br />INSURER r;
<br />SanladL Fe SPrings CA
<br />90670
<br />INSURER 1� �
<br />r1n11I=0Ar1I=Q 11
<br />---
<br />—_LINSUITER,�_
<br />EA(( -i
<br />THIS IS TO CERTIFY -1`7/777-M-1-77
<br />�NDICA I ED,
<br />'1177 OF -K REVISION NUMBER:
<br />SURANCE LIS I Eli BELOW I 1AVE 3H N 3�, LED TO THE INSURED NAMED ABOVE FOR THE TIOLICY —PER75
<br />NO]WITHSTANDING AN
<br />' REQUIREMENT, IERM OR CONI)i T ION OF ANY rXA I RAC T OR 0 FHER DF)CUMEN I WIT'II RESPEC
<br />CER$ FICAIF MAY BE ISSUED OR A
<br />F R,) Wl-flCH THIS
<br />AY PEPIAIN PIE INSURANCE AFFORDED BY iEIE POLIG'ILS DESCRIBED HEREIN IS
<br />EXCI.USONS ANf,,7CO(ql)lr[t)NS OF S
<br />SIJBJE(J[' F0 AI i'FHL TERmS
<br />)GH POLICES LiWTS SHOWN MAY HAVE BEEN R'JAICEDBY PAID CLAwS
<br />NSR
<br />_LTR TYPE Or INSURANCE
<br />ADDL SUER FOUCY EFF POLICY EXP
<br />POLICY _NUMBFR LIMITS
<br />COMMERCIAL GENERAL L M,81L.DY
<br />FACH 0CCURRNqCr, $
<br />CI AWSMADI-' OC, ajR
<br />DAMAGE rO REN"RD
<br />'Rr'MISF8 (F,%,
<br />WD EXP (A,,yrune
<br />PI.-RSONAL & ADV Ir,IJ6JEY
<br />OF"N'l
<br />PW
<br />U -NERAL A'3rkKGATF $
<br />POL Gly I&C r LUC
<br />(rPiFR
<br />$
<br />AUTOMOOILE UASILITY
<br />CC
<br />J -a '1) 11000,000
<br />ANY AU 10
<br />NODILY INJURY (Por $
<br />A. OWNFL) SCHMAJU'D
<br />AL901 ALP 6,17,
<br />8"647 35 51 4/1.6/2016 4/16/2037 BODIT Y N,juRY
<br />N0N,0VVNH)
<br />I flRFD M A (MEAlu I 0,
<br />PROPER'lY IrAMA(Ij-
<br />UMBRELLA LIAR OCCUR
<br />EXCESS LIAR
<br />EA(( -i
<br />CLAIMS N
<br />4W
<br />w-ut47w,�qs
<br />WORKERS COMPENSATION
<br />71FR - --------
<br />AND EMPLOYFJiS'LIABII. ' ITT
<br />'/N STARJTF
<br />ANY I'R,IFTOR,PARINV..�R�r.Xr�,;I1r VF
<br />C)Fr:GFfAA40A8C.R r.XCI LJ) r. 0
<br />N/A E 1, EACH ACCAJEN T $
<br />(Mandatary in NHi
<br />nISFASI' - EA EMFI�(�Yr�t� S
<br />Et NSE A'2"
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /W HICUS
<br />EUNiCEHEREDIA(I"G ioF
<br />U-"4LcLLA I
<br />[faK:Permits@City of Santa
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana, A-93 THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN
<br />20 Civic Center Pla4a ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Santa Ana, CA 9270Z
<br />AUTHORIZED REPRESENTATIVE
<br />YS
<br />R Clem, CIC/VICK
<br />(q) 1988-2014 ACORD CORPORATION, All rights rese,Ved.'
<br />ACORD 25 (2014Y01) The —AC -ORD DEMO and logo are registered marks of ACORD
<br />UNS025 (,,m4(m
<br />
|