NATIONAL DEMOLITION CONTRACTORS - 2017

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NATIDEM-01 JHOJNACKI CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER- RFVISInNI NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DATE 02/23/2017Y) 02/23/2017 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(les) 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 License # OD28764 Orion Risk Management Insurance Services, Inc. 1800 Quail Street, Suite 110 Newport Beach, CA 92660 CONTACT NAME: PHONE e, Ext) 949 263-8850 FAx ) ) (AIC, Ne):(949) 2_63-8860 ADDAIL RESS: __. INSURER(S) AFFORDING COVERAGE NAIC # POLICY EXP MM/DD YYYY INSURER A: State Compensation Insurance Fund 35076 _ _ INSURED INSURER B: INSURER C: National Demolition Contractors 1536 W 25th St., Ste 248 San Pedro, CA 90732 INSURER D: --- $ DAMAGE TO RENTED PREMISES (Ea occurrence)_ $ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER- RFVISInNI NIIMRFR• 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 NSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD YYYY POLICY EXP MM/DD YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADEEl OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence)_ $ MED EXP (Any one personL_ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE� LOC GENERAL AGGREGATE $ GEN'L PRODUCTS =COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY Per person $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accidentl $ DAMAGE (Per accident) $ HIRED NON-OWNEDPROPERTY AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 156730316 10/01/2016 10/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE — $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 142714 CERTIFICATE HOLDER CANCELLATION if SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ross Annex (M--36) AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 -?OVA AGUKU Zb (ZU] b/U3) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD