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<br />ADRSERV-01BMITROSILIS
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<br />DATE(MM/DD/YYYY)
<br />CERTIFICATEOFLIABILITYINSURANCE
<br />Ebuf;!3133/14/22!
<br />3/8/2022
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<br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS
<br />27;69;36!.19(11(
<br />CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES
<br />BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED
<br />REPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER.
<br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed.
<br />IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementon
<br />thiscertificatedoesnotconferrightstothecertificateholderinlieuofsuchendorsement(s).
<br />CONTACT
<br />License#0633339
<br />PRODUCER
<br />NAME:
<br />PHONEFAX
<br />OlsonDuncanInsuranceServiceInc.
<br />(310)373-6441(310)378-5336
<br />(A/C,No,Ext):(A/C,No):
<br />25550HawthorneBlvd.Suite203
<br />E-MAIL
<br />ins@olsonduncan.com
<br />Torrance,CA90505
<br />ADDRESS:
<br />INSURER(S)AFFORDINGCOVERAGENAIC#
<br />SentinelInsuranceCompanyLTD11000
<br />INSURERA:
<br />INSURED
<br />EmployersCompInsCo11512
<br />INSURERB:
<br />INSURERC:
<br />ADRServices,Inc.
<br />1900AvenueoftheStars#200
<br />INSURERD:
<br />LosAngeles,CA90067
<br />INSURERE:
<br />INSURERF:
<br />COVERAGESCERTIFICATENUMBER:REVISIONNUMBER:
<br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD
<br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS
<br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,
<br />EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS.
<br />INSRADDLSUBRPOLICYEFFPOLICYEXP
<br />TYPEOFINSURANCEPOLICYNUMBERLIMITS
<br />LTRINSDWVD(MM/DD/YYYY)(MM/DD/YYYY)
<br />2,000,000
<br />A
<br />COMMERCIALGENERALLIABILITY
<br />X
<br />EACHOCCURRENCE$
<br />DAMAGETORENTED
<br />100,000
<br />CLAIMS-MADEOCCUR
<br />X
<br />72SBANK42238/30/20218/30/2022
<br />$
<br />PREMISES(Eaoccurrence)
<br />10,000
<br />MEDEXP(Anyoneperson)$
<br />2,000,000
<br />PERSONAL&ADVINJURY$
<br />4,000,000
<br />GEN'LAGGREGATELIMITAPPLIESPER:GENERALAGGREGATE$
<br />PRO-
<br />4,000,000
<br />X
<br />POLICYLOC
<br />PRODUCTS-COMP/OPAGG$
<br />JECT
<br />OTHER:$
<br />COMBINEDSINGLELIMIT
<br />2,000,000
<br />A
<br />AUTOMOBILELIABILITY
<br />$
<br />(Eaaccident)
<br />ANYAUTO 72SBANK42238/30/20218/30/2022
<br />BODILYINJURY(Perperson)$
<br />OWNEDSCHEDULED
<br />AUTOSONLYAUTOSBODILYINJURY(Peraccident)$
<br />PROPERTYDAMAGE
<br />HIREDNON-OWNED
<br />XX
<br />(Peraccident)$
<br />AUTOSONLYAUTOSONLY
<br />$
<br />1,000,000
<br />A
<br />XX
<br />UMBRELLALIABOCCUR
<br />EACHOCCURRENCE$
<br />72SBANK42238/30/20218/30/2022
<br />1,000,000
<br />EXCESSLIABCLAIMS-MADE
<br />AGGREGATE$
<br />10,000
<br />X
<br />DEDRETENTION$
<br />$
<br />PEROTH-
<br />WORKERSCOMPENSATION
<br />B
<br />X
<br />STATUTEER
<br />ANDEMPLOYERS'LIABILITY
<br />Y/N
<br />EIG2832016024/15/202110/1/2021
<br />1,000,000
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L.EACHACCIDENT$
<br />N/A
<br />OFFICER/MEMBEREXCLUDED?
<br />1,000,000
<br />(MandatoryinNH)
<br />E.L.DISEASE-EAEMPLOYEE$
<br />Ifyes,describeunder
<br />1,000,000
<br />DESCRIPTIONOFOPERATIONSbelowE.L.DISEASE-POLICYLIMIT$
<br />DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES(ACORD101,AdditionalRemarksSchedule,maybeattachedifmorespaceisrequired)
<br />CertificateholderisanAdd'lInsuredCAperformSS00080405ifrequiredbywrittencontractoragreement.
<br />InsuredhasProfessionalLiabilityInsuranceasfollows:
<br />AlliedWorldInsurance,policy#0312-3517,policyperiod:5/17/21-22
<br />$3,000,000EachClaim
<br />$3,000,000Aggregate
<br />$50,000Retention
<br />SEEATTACHEDACORD101
<br />CERTIFICATEHOLDERCANCELLATION
<br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE
<br />THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN
<br />CityofSantaAna
<br />ACCORDANCEWITHTHEPOLICYPROVISIONS.
<br />RiskManagementDivision
<br />20CivicCenterPlaza
<br />AUTHORIZEDREPRESENTATIVE
<br />SantaAna,CA92702
<br />ACORD25(2016/03)©1988-2015ACORDCORPORATION.Allrightsreserved.
<br />TheACORDnameandlogoareregisteredmarksofACORD
<br />
<br />
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