—�� 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 />
|