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Policy Number: 601757268
<br />Date Entered: 6 / 14 / 2 019
<br />Ac"# " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM DD YYYY)
<br />Ilk�
<br />6/14/2019
<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 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
<br />CONTACT Cori Mann
<br />NAME:
<br />B.W. Baker Insurance Inc.
<br />AICPHONE Ext: (310) 457-5092 (A po: (310) 457AK -6225
<br />29169 Heathercliff #208
<br />E-MAIL
<br />Malibu, CA 90265
<br />ADDRESS
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />Farmers Insurance Exchange
<br />INSURER A:
<br />INSURED Integra Ellis Group Ellis Group Inc.
<br />INSURER B: Farmers Insurance Exchange
<br />INSURERC: Farmers Insurance Exchange
<br />Lea Associates Inc
<br />INSURER : Farmers Insurance Exchange
<br />16030 Ventura Blvd., Suite 620
<br />INSURER E:
<br />Encino, CA 91436-2785
<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 TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMB ER
<br />POLICYADDLISUBRI
<br />MM/DDIYYYY
<br />POLICYLIMITS
<br />MWDD/Y YY
<br />p,
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />Deduct $10,000
<br />X
<br />601757268
<br />10/29/2018
<br />10/29/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea occurrence
<br />$ 75, 000
<br />IVIED EXP(Any one person)
<br />$ 5,000
<br />Contractual
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY jE O- LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2, 000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 1,000, 000
<br />$
<br />B
<br />AUTOMO BILE LIABILITY
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />601757268
<br />10/29/2018
<br />10/29/2019
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />MAGE
<br />Par eer.IdeN
<br />$
<br />C
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />605078431
<br />10/29/2018
<br />10/29/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />DED I I RETENTION $
<br />$ 1,000, 000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N
<br />OFFICER/MEMBER EXCLUDED? ly
<br />(Mandatory In NH)
<br />IF yes, descdbe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />A09458634
<br />8/13/2018
<br />8/13/2019
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000, 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000, 000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Bus. Pars. Property
<br />X
<br />601757268
<br />10/29/2018
<br />10/29/2019
<br />rc/special
<br />$251, 000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />30 day notice of cancellation/10 day notice of cancellation for non -pay.
<br />Certificate holder and its affiliates are named as additional insured.
<br />Location: 16030 Ventura Blvd., Suite 620, Encino, CA 91436 473. Evidoac O I
<br />R I ED BY:
<br />IiCR I Ir'IVMI r- r7VLLJGR t It 1 /I 1/ / 1 I ■ 1 vl vrv.vrrrr w..
<br />City of Santa Ana I�
<br />Risk Management Division fs ma Ogem't Dii ivfs Q SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />401
<br />n 19RR-7015 ACORD CORPORATION. All riahts reserved.
<br />ACORD 25 (2016/03)
<br />The ACORD name and logo are registered marks of ACORD
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