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BUSIEMP-01 KDEMPS <br />CERTIFICATE OF LIABILITY INSURANCE DATE 09/19/2018 Y) <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(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER License # 0757776 N01' ACT Karen Dempsey <br />INSURED <br />International Insurance Services Inc. <br />I, Suite 350 <br />Business Empowerment Inc. <br />1805 E Dyer Rd Ste 109 <br />Santa Ana, CA 92705 <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 <br />DOCUMENT WITH RESPECT TO <br />WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br />THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />F INSURANCE ADDL SUBR FOUCY NUMBER POLICY EFF POUCYEXP <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />1'D00'808 <br />ADE X OCCUR 72SBAAP9356 06/19/2018 06/1912019 <br />X10'808 <br />DAMAGETORENTED <br />rAGGREGATE <br />1,000'000 <br />PERSONAL & ADV INJURY $ <br />E LIMIT Af'%...IES PER:GENERALAGGREGATE <br />$ <br />2,000,099 <br />� LOC <br />PRODUCTS-GOMP70PAGG $ <br />2,999,090 <br />A AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />1�gO0�ggg <br />ANY AUTO X 72SBAAP9356 06/1912018 06/19/2019 <br />BODILY INJURY Per arson $ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />H_X <br />BODILY INJURY (Per accident <br />A[ITf7S X ARTNO WN D <br />PerOa dent GL $ <br />ONLY <br />-... <br />UMBRELLALIAB _ OCCUR <br />EACH OCCURRENCE <br />EXCESS MAE CLAIMS -MADE <br />AGGREGATE $ <br />DED RETENTION $ <br />B WORKERS COMPENSATION <br />0TH <br />X STATUTE <br />AND EMPLOYERS' LIABILITY YIN 7ZWECKU2622 9411512016 9411512019 <br />_............. <br />1.000,090 <br />Y PROPRIETORJPARTNERIEXECUTME <br />Y NIA <br />AANNand <br />E.L. EACH ACCIDENT $ <br />_ <br />(rerny"�n NHCLUDED? <br />at <br />E.L. DISEASE - EA EMPLOYEE $ <br />1'909'990 <br />If es,desube under <br />1'000,000 <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ <br />— I - I -_ I T_ <br />I - I <br />DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES (ACORD 101, Addiconal Remarks Schedule, ma he attached if m space is required) <br />The City of Santa Ana, its officers, employees, agents, and representative are nameyas additional insured In regards to General Liability per attached form <br />30 Day Notice of Cancellation applies except a 10 day notice applies for non payment of premium <br />CFRTIFICATF Mini nFR C.ANCFIA ATION <br />ACORD 25 (2016/03) ©19882015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) ©19882015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />