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I CERTIFICATE OF LIABILITY INSURANCE <br />N , 2-0 ib -z s <br />DATE (MMIODNYYY) <br />12/13/2018 <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(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />HILL & USHER INS & SURETY/PHS <br />CONTACT <br />NAME: <br />A <br />COMMERCIAL GENERAL LIABILITY <br />--1CLAIMS-MADEOCCUR <br />FXIPREMISES <br />X General Liability <br />59302202 <br />59 SBWRV1649 <br />THE HARTFORD BUSINESS SERVICE CENTER <br />12/19/2018 <br />EACH OCCURRENCE $1,000,00 <br />3600 WISEMAN BLVD <br />SAN ANTONIO, TX 78265 <br />PHONE <br />Ext): (866) 467-8730 <br />FAX <br />IAC, No); (888) 443-6112 <br />E-MAIL <br />1 <br />ADDRESS: <br />PERSONAL &ADV INJURY $1,000,00 <br />INSURER(S) AFFORDING COVERAGE NAICN <br />INSURED <br />INSURER A: The Sentinel Insurance Company 11000 <br />PHOTOGRAPHY BY JOSHUA BOBROVE <br />INSURER B: <br />2419 VISTA DEL CAMPO <br />INSURER C: <br />SANTA BARBARA CA 93101-4662 <br />12/19/2017 <br />INSURER 0: <br />COMBINED SINGLE LIMIT $1,000,000 <br />(Ea accident) <br />- <br />INSURER E: <br />INSURER F: <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 DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSH <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBB <br />WVO <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD <br />POLICY EXP <br />MMI DIYYYY <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />--1CLAIMS-MADEOCCUR <br />FXIPREMISES <br />X General Liability <br />59 SBWRV1649 <br />12/19/2017 <br />12/19/2018 <br />EACH OCCURRENCE $1,000,00 <br />DAMAGE TO RENTED $1,000,00 <br />Ea occurrence <br />MED EXP (Anyone person) $10,00 <br />1 <br />PERSONAL &ADV INJURY $1,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑Eo- LOC <br />OTHER: <br />GENERAL AGGREGATE $2,000,00 <br />PRODUCTS-COMPIOP AGG $2,000,00 <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />X HIRED AUTOSX NON -OWNED <br />AUTOS <br />59 SEW RV1649 <br />12/19/2017 <br />12/19/2018 <br />COMBINED SINGLE LIMIT $1,000,000 <br />(Ea accident) <br />BODILY INJURY (Per person) <br />BODILY INJURY(Peraccident) <br />PROPERTY DAMAGE <br />Per accident <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />AGGREGATE <br />DED <br />RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yea, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />IPER OTH- <br />ISTATUTE <br />E.L. EACH ACCIDENT <br />E.L. DISEASE -EA EMPLOYEE <br />E.L. DISEASE -POLICY LIMIT <br />DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks schedule, may be attached if more space Is required) <br />Those usual to the Insured's Operations. Z/1 %// 9 <br />r F:RTIFIr:ATF Hnl nFR CANCELLATION <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />220 S DAISY AVE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />SANTA ANA CA 92703-4334 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />CJ'41®a'1� 1�r Cgot.� <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />J <br />RE <br />