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—�� BUSIEMP-01 KDEMPS <br />coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br />4%�8/28/2019 <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 License # 0757776 MEdcT Karen Dempsey <br />La Palma, CA - HUB International Insurance Services Inc. PHONE , Exq: (562) 674-2527 FAX No): <br />6 Centerpointe Drive, Suite 350 (A/C, IL <br />La Palma, CA 90623 E-MAADDRESS, Kareii.Deiiipseyighubinternational.com <br />1000 <br />INSURED <br />Business Empowerment Inc. <br />1805 E Dyer Rd Ste 109 <br />Santa Ana, CA 92705 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 <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 <br />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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP <br />LIMITS <br />A X COMMERCIAL GENERAL LIABILITY <br />EACHOCCURRENCE $ 1,000,000 <br />ICLAIMS -MADE I X I OCCUR X 72SBAAP9356 6/19/2019 6/19/2020 <br />DAMAGE TO RENTED <br />MED EXP (Any, one persons $ 10,000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />_ <br />GEN'L AGGREGATC LIMIT APPLIES PER: <br />AGGREGATE $ 2,000,000 <br />- POUCY jraj I LOC <br />_GENERAL <br />PRODUCTS - COMP/OP AQG $ 2,000,000 <br />OTHER: <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />,,OMBiNED SINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />ANY AUTO <br />X <br />72SBAAP9356 <br />6/19/2019 <br />6/19/2020 <br />$ <br />OWNED SCHEDULED <br />AIURTEO�S ONLY AUTOSSWNEp <br />_ <br />$ <br />BODILY INJURY (Per accident). <br />X AUTOS ONLY X AUOTOS ONLY <br />r ae r4E <br />$ <br />UMBRELLA LIAB _ OCCUR <br />EACH OCCURRENCE. <br />_$ <br />$ <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE <br />$ <br />DED RETENTION$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />AND N <br />ANYPROPRIR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? � Y <br />(Mandatory lnNH) <br />NIA <br />72WECKU2622 <br />4/15/2019 <br />4/15/2020 <br />OATH - <br />X I PER H- <br />TA IE <br />1,000,000 <br />$ - <br />$ 1,000,000 <br />- E,L EAGH ACCIDENT <br />E.LDISEASE -EAEMPLOYEE <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />1,000,000 <br />__ <br />I E,L DISEASE - POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />The City of Santa Ana, its officers, employees, agents, and representative are namedasadditional insured In regards to General Liability per attached form <br />30 Day Notice of Cancellation applies except a 10 day notice applies for non payment of premium <br />REVIEWED & APPROVED <br />By RISK MANAGEMENT DIVISION <br />SEP 12 2019 <br />CERTIFICA <br />City of Santa Ana <br />Risk Management Division <br />2020 Civic Center Plaza 4th Floor <br />Santa Ana, CA 92701 <br />ACORD 25 (2016/03) <br />CANCELLATION <br />-M <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 />*&A- Z�L <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />