|
DATE (MWDDNVYV)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1110W2021
<br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON'THE CERTIFICATE HOLDER. THIS
<br />CERTIFI,CATE 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 CERTIFIGATE HIOLDER.
<br />IMPORTANT., If the oeTtificale hiolodILr is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be, ondorsed..
<br />If SUBROOATION IS WAIVED, subject to the terms and conditions, of the policy,. certain policies may roquiro an endorsement, A Statement on
<br />this cartiheata doas not confer irighte to the certificate holder in fleu of Such endorsernontfs),
<br />Tom Saumur Insurance Agency N.AME
<br />mbNr' - - — --------------------- T��A
<br />4242 Obispo Ave (W', M49 F"�L ................ . ....... . . ...... ...................
<br />E-MAK
<br />Lakewood C.A,901712 . . . . . . . . . ........ . ...... .............. . .
<br />NAIG1
<br />.. . . . .. . . . ................................................. .IrtiY34afk.E1R.A . . ............ . ........................
<br />Casa Do La Farnifia Inc
<br />1650 E 4th St
<br />Santa Ana Ca 92701
<br />ludson Insurance
<br />COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:
<br />THIS 13 FO ClRIIFY II -Al 11 IE POLICIES Or- INSURANCE LIS7ED BELOIN HAVE SEEK, ISSUED TO THE IN$URET) NAMEh� A130VC [h"OR 11 IE POLICY PERIOD
<br />INDiCATED. NOTWITI iSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CQKTRACT Dr () I'FIER I)OCI)MIENT Wll1 I RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE SORIBF",f) HERON IS :I!LMJIECT TO ALL THE TERMIS.
<br />LXCLUMONS AND CONDINONS OFSUCH POIACIES LIMITSSHOWN MAY HAVE BEEN REDUCED BY` PAID 0I.AIM$.
<br />. .. . . . ................. . .... .. . . . ... ...... ............................ . ........................
<br />SUBRI POLICY EFF PIOLKV EXP
<br />TYPE OF INSURANCE PMIGY NIUMBF;R (MM,DDIYYYYI 14000,,YYVVI LEMITS
<br />GENERAL LILIABILITY
<br />E6GH 001-JRRINCE 13
<br />.. ... . .........
<br />. ................
<br />ME.. . ..... ....... .........
<br />1' ) E .2M [:9 P0 !3
<br />I KIP" !S
<br />GENT AGGREGA rL L�,MIT APPL pl•k: y
<br />. ..............
<br />wx'10 IO, PRODLA'7S - GOMRk")p i('i
<br />AUTOMOHM, 11 E ll I. "I I I A I'll F 11 1 I'll I "I I I "1 7 I'll, Y "I'l""I'll""I'll'll""I'll""I'll",'ll,�,-�Ill""--,�,�'ll,�,"I ........... C37Km �N Er, —swo r I 7Tk il .. . ... . .... . .......
<br />iiI 2 L1 I —rlr I E 1. 2--ij j .. .................. . "I'll , 5
<br />,WY Aur.o 1 WWII V INJI)KY (PprpW,40�1) 5
<br />. . ...... . . .. ........
<br />WM-'o fir
<br />AkOfirn, ONI'y II)II V INAL)KY k1lor
<br />1111-19 NOWLPANEC) OPERTV DAAMGE� 5
<br />A010S I)NI y Am 01S cwy Par 1-r1ruL
<br />. . .. ..... ..
<br />UMBREIAA UAB (,)CCjR EAC 110 C:C J R R E NIC C
<br />EX,C E:55 L.IAI3
<br />DrD R:TENTI�JN S—
<br />i�6Kf RS 666KFENSATION pEk 1 K-
<br />Ar4D EMF`I,GYERS'LIAI3IWTY VN i I ] -.......................
<br />AN�,PROPI),IiETC,,R�PART�IER�'[!KECU FNE 9248318-19 X2X20211 0,af212022 S1000'00
<br />crncr R.-&Omm EXCLUDED? NIA . . . . ... .. . . .............. . ......
<br />IMandalury in N11i I
<br />11 duNci nuu- ixule7
<br />'Y D SCRT710N 07, OPERA71ONG tx!hyx E.L, DI.GEA, -�fn �E . . ..... 51,000,000
<br />C qq
<br />Empivyer Liability 104.000 Rolonijun
<br />Includes-Suxual MiscondLICt Liability p FP-HN-NPP-3783 3411,6f,2021 0,4A&2022 1,000,000 Aggragate
<br />pruidirel
<br />DESCRIPTION OF OPERAMONS I'LOCATIONS.1 VEHIGLES IACORD 101, Additional Reimarks Schaduln, may lie atlachnd IN imorn n pare Rn roquiroari
<br />ertificate Holder Ulsted as Additional Insured
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana SHOULD ANY OF THE ABON VE DESCRIBED POLICIES CAE GKEIL QLIED BuFORI�-
<br />Risk Management Divison THE EXPIRATION DATE THEREOF, NOTME VUrILL, BAE DELIVERED IN
<br />2C Civic Center Plaza 4Th Floor ACCORDANCE WITH THE POLICY PROVISIONS -
<br />Santa Ana, Ca 92!701
<br />EDREPRESENTATIVE
<br />%&MwaganedDiMsiun
<br />0) 1988-2015 AC�ORD CO� ,7p' REVIEWED &APPRCYVEDBY.-
<br />ACORD 25112016103) The ACORD name and logo are registereld marks of ACORD
<br />Profluced 'JAIM9 l'offlis 606s Web Software. www,Forir,0osij,eut,i; y 11wrNpru5sive Publml-iing 9 0,2094977
<br />Risk Management Analyst
<br />
|