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WISECAC-Cl ------- E—W—kY
<br />(
<br />CERTIFICATE OF LIABILITY INSURANCE i 0DATE 1MI12019 MMMDIWYY)
<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 INSUR5R(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of
<br />PRODUCER
<br />Belton t 900,TIVA 3476 E. F Blvd., Suite 100
<br />Pasadena, CA 91107
<br />INSURED
<br />Wisiplace, CA Corp. Wise Silver Center ribs:
<br />1411 N. Broadway
<br />Santa Ana, CA 92706
<br />must have ADDITIONAL INSURED provisions or be Endorsed.
<br />certain policies may require an Endorsement. A statement on
<br />AGES PERIIPICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIrY 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 MICH 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 />—
<br />A R
<br />Imn mr, __ - - - __ PCL_1CY_�IUM11R F619MF)_
<br />UNITS
<br />A X I COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE t 1,000,000
<br />CLAIMS-MAOV, OCCUR X PHPK1924744 0110112019 01/012020
<br />100,000
<br />6,000
<br />,EXP &42oF ,0
<br />.Mile_L _W,,W _, J___
<br />000
<br />_F'.E&E.0 L �&�v _MOG!"
<br />qWL AGGREGATE LIMI r APPLIES PER, i
<br />QgtIfl �LAGGREGATE.
<br />POLICY TE& LOC
<br />EagnU�FS _-GO _MFvD"G,Q,_, $ 2,000,000
<br />SEXUAL PHYSICAL 1,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />1100%000
<br />I ANY AUTO
<br />HPK`924744
<br />�ip
<br />0110120I9101161/2020
<br />AZA&B AUTOSULED
<br />8ONLY
<br />NURyperLcylini)
<br />XSCHED
<br />N6NSU
<br />ONLY ATOT
<br />_8001Y
<br />%ER Y!AG1XZAT
<br />K
<br />X
<br />UMBRELLA OASX OCCUR
<br />EACH OCCU
<br />1,000,000
<br />EXCESS LIAR CLAIMS -MADE!
<br />I
<br />PHU6660328
<br />01101/2019
<br />01/0112020GGOEOATE
<br />—
<br />—
<br />I
<br />"ES X I RETENTIONS 10
<br />Aggregate
<br />000000
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY 'R�vR'aT"FNFAKTNERIEXECUTIVE YN
<br />EXCLUDED?
<br />NIA
<br />WC204800006833
<br />i
<br />0811512018
<br />081,612019
<br />LEACH ACCIDENT
<br />S 1,000,000
<br />if yes. re%dbe under
<br />RgKWEML�PEFYAUQUjkgL�
<br />DISEASE POLICY LIMIT
<br />1,000,000
<br />S 1,01)(0,000
<br />A
<br />Professional Liamill
<br />+P
<br />H VK 19-2 4 7 TT_
<br />0112019
<br />OV0112020
<br />A
<br />Crime
<br />PHPKI924744
<br />PH
<br />1101/2019
<br />0110112020
<br />DESCRIPTION OF OPERATIONS I LOCATIONVVEHICLES (ACORD 101, IHIIIII MNeuerk, Schedule, MAY be Seethed B more apedA Is requirun
<br />GL Additional insured applies per CG2013003 attached, only if required by written contractiagreenvenIL
<br />Primary and Non -Contributory Wording applies per PIGLODS07112 attached.
<br />Additional Insured(s): City of Santa Ana, Its offleens, employees, agents, volunteers and representatives.
<br />RV: Operations of the named insured.
<br />A,
<br />r CDTUnr`AT Will CIPW (AMr.91 I ATIMN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OF, 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) @ 1988.2015 ACORD CORPORATION. All rights reserved,
<br />The ACORD name and logo are registered marks of ACORD
<br />
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