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MEKONG1 OR ID: RG
<br />CERTIFICATE OF LIABILITY INSURANCE J� Ot111DA0E (MMIODMYY)
<br />61111219 019
<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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement oil this certificate does not confer rights to the
<br />nce Services, lnc.
<br />I
<br />rn Ave. Suits 400
<br />CA 90040
<br />INSURED Mekong Printing, Inc. INSURERBIReturredEmployersIns,Co. 1091)0
<br />DBA: MK Printing ...._.w ...._..__._ _.._ - _._-- ( ...
<br />2421 W. First Street INSURER C ..
<br />Santa Ana, CA 92703 .INSURER D :
<br />INSURER E_
<br />INS F
<br />COVERAGES CERTIFICATE NUMBER: [REVISION NUMBER:
<br />m THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS
<br />UED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WI'rl I RESPECT TO WHICH TI-5S
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI. THE TERMS,
<br />EXCLUSIONS AND OONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />[RED __ _. . .... nb,Yi. 4IJAII' _..... ,..., _. _-...__ POEICYEFF R'oL(6Y'
<br />TYPEOFINSURANCE :IH46, w+1n) d'QLlsj".Md[H,MER 1 ,1,(fij�1gC I LIMITS _
<br />GDNLRALI]ABlUrRY l EACH OCCURRENCE a 1,000,00E
<br />A A (*MMERCIAL GENERAL LIABILITY Y j H391d0005.08 05/19/2019 05/19/2020 nAIAAOF TO HENTtO
<br />l ARIMWFS.IExlaccwmm,} .$ i B0,05E
<br />CLAIMS -MADE [X.. OCCUR RED EPP(Anyonaporeon) S 10,00E
<br />PERONAI. A ADV INJURY ?S 1,000,00E
<br />R GL BROADEN ENDT -- ' ( GENERA[AOQRr(ATI $ 2,000,00]
<br />� GPN,AGGRFOATE LIMITAPPLIFS PER: j PRODUCT COMP/OP AEG_ $ INCLUDED
<br />Pltn .. __
<br />POLICY j I T .. LDC I Emp Ben. a 1,000t00E
<br />... l'f°'�IIh1r
<br />AUTOMOBILE LIABILITY { ��I&+�8rI40dPnt). $ 1,000,00(
<br />A X ANY AUTO AW3 9147434-00 05119/2019 05/19/2020 Bt7N Y INJURY (rat Pe,eor) . $
<br />ALL OWNED SCHEDUI ED BODILY INJURY (I ar a<cWent) $
<br />..'AUTOS AUTOS ..
<br />NON -OWNED , PROPL'RTYDAMA-GI'
<br />HIREDAUTOS _._ AUTOS WERACP.IDENT)
<br />i$
<br />X uMBRELLALKS X OCCUR rAPrl or ruRHrracE $ 1,000,00(
<br />A EXCESS LIAR CLAIMS -MADE tJH3999155098 05/19/2019 55/19/2020�AGaRrGAITE $ 1,000,00(
<br />DED I X I RE'I EN['ION$:.... _d I .. -- S
<br />,�.,_...�....... .a...._.__......�
<br />ry WORKERS COMPENSATION E W3AR Ir -TI -O_-T_-H-
<br />ANDEMPLOYERS'LiABILITY ORY{,[MITE[ .I ri -
<br />B ANY PROPRIE.TORIPARTNEMEXECUTIVE YIN 1 ( WKNI50180.6 0710112018, 07101/20191 E L EACH ACCIDENT $ 1,000,00(
<br />OFFIOERIMEMBrRPxGlA)DPD9 INIA -- --- --
<br />'(Myandatarph, NHI ,E,L. DISEASE EA EMPLOYEE 1,000,00(
<br />i DESCRIPTION or OURATIONShslow I i E.L. DISEASE POLICY I [MIT S 1.,A0D,OQI
<br />OESCROI'ION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORO 191, Additional Remarks Schedule, it more apace is re -.d)
<br />The City of Santa Ana, it's officers, employees, agents and repree entative
<br />are named as Additional Insured in regards to General Liability per r
<br />COMMERCIAL GENERAL LIABILITY SPECIAL BROADENING & ENHANCEMENT ENDORSEMENTS BY.
<br />**PROOF OF WC COVERAGE ONLY ** > ,
<br />SANTAAN
<br />The City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />J. OAF
<br />© 1988-2010 ACORD
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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