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k3LU5MAN-02 GINBODEN <br />CERTIFICATE OF LIABILITY INSURANCE DATE 1 612512019 <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 18 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 a . <br />PRODUCER License # 0019762 gRAJACT <br />Momentous Insurance Brokerage Inc PRONG PAX <br />6990 Sepulveda Blvd., 11550 IAlC, No,Lxtr (818) 933-2700 1AJC, uolr(818) 933-2701 <br />Van Nuys, CA 9141111as; <br />INSUHERISI AFFORDING, COVERAGE NA104 <br />;INSURER Al Philadelphia Indemnity Insurance Company 18058 <br />INSURED ; INSURER a: Sentinel Insurance Company 11000 <br />Blueray Management LLC : INSURER C c <br />P.O. Box 12629 INSURER D: <br />Newport Beach, CA 92658 <br />INSURER E: <br />INSURER PI <br />F-1^1/F13 ARRC n9T0'r tf-Arr; inn 11HIM M. oc.rrainkr re,ras000. .... <br />THIS IS TO CERYIPY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDIOATO. NOTVNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER 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 THE TERMS, <br />EXCLUSIONS AHD 00NDITION3Of SUCH POLICIM, LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. <br />&R TYPE CF INSURANCE GDG HR; POL{CY NUMBER POLIO 6F POLICY EXP <br />LIMITS <br />A : X COMMERCIALOUNBRALLIABILITY <br />2,000,000 <br />EACH OCCURRENCE $ <br />CLAIM: -MADE X '; OCCUR PHPK1938138 312412D19 ' 3124l202p <br />X <br />DAMAGE 70 RENTED <br />PREMISES($n oCCUnenoe) $ <br />10U,DDU <br />I <br />MED EXP (Any one person) S <br />D <br />! <br />PERSONAL& ADV INJURY 3 <br />2,OUD,DDO <br />�GEN'LAGGRgGATELIMIT APPLIES PER: + <br />GENERAL AGGREGATE S <br />4,000,000 <br />r POLICY: j LOC { r <br />i <br />PRODUCTS -COMPIOP AGO 3 <br />4,040,000 <br />A : AUTOMOBILE UARILITY <br />[EOM131 31NGLI LM(T <br />1,DOD,000 <br />$ <br />X ANY AUTO PHPK1938138 3/24/2019 ; 312412020 <br />BODILY INJURY (Per person) $ <br />� <br />RUN�IOES x <br />• <br />ONLY ; FN,i�r)'4S t <br />BODILY INJURY IPeraccIdent)• $ <br />X ' AUT03 ONLY AU7� <br />u6ucErli;duYr1) AMAGE $ <br />S <br />UMBRELLALIAS ; OCCUR <br />EACH OCCURRENCE i <br />EXCESS LIAR CLAIMS -MADE <br />-AGGREGATE t: <br />{ UED RTENTION $ <br />yNPLOYCLBIITYER{AL <br />: <br />CT TUTS Frt <br />!AP1YPLiQPIi7U nfiTlit7t7FGUTIVE YIN , <br />I +M M >xCLUDED7 :NIA' <br />E.L.EACHACCIDENT $ <br />! An a my n ) <br />E.L.UISEASE-EA EMPLOYEE$ <br />ill <br />RIE916Hu r OEERAtPDN8bola - <br />E,1..DlSEnsr_-PpLIGYI,RAff 3 <br />B •BDsineSa.Own ara PCII 7258l1AR9861 3/10/019 : 311612020 <br />F3PP <br />50,DOD <br />DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES JACORD 191, Additional Remarks Schedule, maybe attached IF more Space Is required) <br />R IWDB. <br />� 2-1 <br />City of Santa Ana, Risk Management <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 />y� Q� <br />- �. v iauo-au is MvOnir vvnrwmA I ium All rlgms reservetl. <br />The ACORD name and logo are registered marks of ACORD <br />