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Francine R. Villareal Digitally signed by Francine R.Villareal
<br />Date: 2021.02.2615:20:06-08'00'
<br />CERTIFICATE OAF (LIABILITY INSURANCE
<br />OATS (RMAIOOLVYYYYN'
<br />THIS CERTIFICATE IS ISSSUIIEID AS A MATTER Of INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DIES NOT AFFIRMATIVELY OR. NEGATIVELY AMEINNID„ EXTEND OR ALTER. THE COVERAGE AFFORDED BY THE POLIICNER
<br />BELOi W. THIS CERTIFICATE NSF 11INSU DANCE DOES NOT CONSTITUTE A CONTRACT BE''TWF-EN THE ISSUING INNERER( )„ AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE (HOLDER.
<br />IMPORTANT. If the cerdficate holder Is an ADDITIONAL INSURED, the polibcy(Ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subjIect to the terms and conditions of the policy, certain po0cles may r 4ulre on endorsoment. A statement on
<br />PRODUCER MINI I MU I IN'tRC'h DeIIC,Nt
<br />R II~,G In5ur��arn a Services PHONE FAX
<br />303 E'4,�uacker Dir Ste 650 �ar� r�� ��� 31 - 56_ 4Cl __________________I t� .11"64
<br />Chicago25
<br />E-MAIL rdoiich rbninsgranoo^.conn
<br />IINNSUREICI SAFELI-C-01 IM✓JIsuRE ',!s w Hartford Casualty Insurance Co ......, 2 24.....,
<br />Iln0- Box; 1 8prN uuNfNru l rDUP
<br />F°.M- INSUJRER'C : Navigators In Uranoe Company .2-39-
<br />Boulder CO 80308 INSURER. ID! Great Aurr ri nl E& Ins„ Co. 3753
<br />IMJsuREAv, � Twin City Furore insurance Co- 29459,,,,,
<br />INSI.'IRER',IF: Priincalcin Exm, Is & Surplos Lines In"r;,rrnr 10780
<br />COVERAGES CERTIFICATE NUMBER. 16625112459 REVISION NUMBER.,
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ILI'-STED BELOW WAVE', BEEN ISSLIIED TO THE INSURED NAMED ABOVE FOR. THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING TAINDIN G ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER
<br />DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSLMED OR. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />HEREIN IIS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,, iLIMITS SHOWN DAY HAVE, BEEN REDUCED BY PAIII C't,A,,IMS
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<br />TYPE OF INSURANCEMPOI MCY MIUMrMBER 4MWDWYYM 4MWDWYYM
<br />LIMITS
<br />A X COMtMiWERCIAL OENERAIL LLABILIT'Y Y Y 8aUEIwIZW3951 1011`2020 113IN20211
<br />M An H OCCIJR�nENrE 1110 aIN,I; O
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<br />IPI Lr ,. �� IMIJINjRY 1,1,000,I afM
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<br />L. QRECATE LIMIT APPLIES PER
<br />CpE; 'WwRAL, AQ�Q ".ECpATE 2,000, fJ
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<br />POUICY ... PRS ILOOC
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<br />PRODUCTS - COMMOP AGG $ 2,050, E
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<br />IR AMNT MN BILELIA III.ArY Y Y I .931JEN7NP19110) 10�30<2020 11W��"„ 0211l
<br />MISINEDSIIIkGLLILIMIT aE. fl,4�}'001M
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<br />" = ANY AUTO
<br />IE0D'IL'Y (INJURY (P�r I'Stl7rntiili� S
<br />OWNED 'WHEDUIED
<br />LSUT( ONLY
<br />BiaMiILY INdJuf�Y (Per ate.. r�II >N
<br />''AUTOS
<br />X HIRED X 14ON-C'd^�MNEL?
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<br />„ A J70 S ONLY AJJ70 S ONLY
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<br />C CIM BREL/LA L MlEt X Y" Y 1 W,1`2020 IVIN202111
<br />OCC4JR�tFiNrE 3 510'001wIT
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<br />X , lE''IIC9 S LIAe CL..AIMI:���WtAADE
<br />AQ91REGA'TE
<br />11
<br />[ ID X RETF rION
<br />WORKERS COMPENSATION Y" 8;1WLCE.CEilr 3 IV1212.0.20 5;12120211
<br />„ETH
<br />AND EM PLOYERS' LIAIBrLIt Y
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<br />wI W *al rrlw r+af?��F`° alr�w la W:wW11VE I�
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<br />E L. Elkf,14A4�C11012'T $ h,000,i 0
<br />OFFICE'RNEPABEREY,C"LL&E DF MildFh,
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<br />(Mmidopiry in N HI
<br />. E.L.IID ISEASE - EA ENMr LDYEE $ I ,rJt�lr,r rl1
<br />DL CRI]PTI)ON OF OPERAT'Ni,Aq desedrieundff
<br />idS P;r�Ij�M;7r�
<br />M- L DISEASE - F""�71N, IC.�Y' I I�"IIT :fir t ,�}fl0, G
<br />D PrX;Wlei"ifoullLiN.GIny TER 28',6w10:5'9' nW302020 lf,0020211
<br />E.Nij'iClalirtni0Agplegralki110,IJI:pM,',7„INLI0
<br />F' F ca c l,iaht e.Ijl„i{3P' M3E,A '- L-LTt1r]C11 '1-I a Mf1i� 9Ca C� nt71,�2a2I
<br />Earkr�r^.�,sA regale 5,600,wo
<br />06:54RIIPTION Of OPERATIONS d LOCATIONS d VE`M CLE IACiC RD 101, Addillminal Remarks kho4ule., dory be allar:hed If mlwg irpwm Is fwviYr'wfjt
<br />The laity of Sanm Ana, !its officers,, Employees, agents and repTesentaitives are adduitionval insured on a primary and
<br />(non-coirtnbutoTy basis as respects the
<br />General Liiabality, , Auto IL,iabiuliiity and UmlbrellaYExcess follows forn'n as required by written contract. Waiver of Subrogation applies In favor of the additional
<br />insured as rrros � kYre General L WorkersCompensationss'folllows form as required byr wri'tt�an contract.. 30, Days
<br />p " Its il�wkiCe Auto
<br />iIE do
<br />m ma rar n�aenbrella."Exa
<br />Notice of Cain Nlaltion with 1C Day yF policy piovisions.
<br />CERTIFICATE, HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE: DESCRIBED POLICIES BE, CANCELLED BEFORE,
<br />THE EXPIRAT loN (DATE THEREOF,
<br />NOTICE WIIMLL
<br />BE DEUVERED IN
<br />N i ly of Santa Ana
<br />AOCORIDANCE V44TH THE. POLICY PROVISIONS.
<br />Risk Management Division, 4th Floor
<br />20 Civic CenterPlaza
<br />AMrUORAZEDREPAESENTA'minp
<br />Santa, Ana CA 92702
<br />�"4— -
<br />1ZisieManagzLlrLentDiviaian
<br />,N GF
<br />REVIEWED & APPROVEDSY.-
<br />1988»2015 AC RD5,
<br />, ,
<br />. v
<br />Ai ORD 25 (2016103) The ACORP name and logo are registered marks *If AICCMR
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<br />Risk Ijar agement ftaly5t
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