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`� v�r� 1 IrIVA I G Vr LIFI�IL1 l i IIY�7t,/R/11VVG 05/03/12 I 1 SOULA- OP ID: M5 14` °R °' CERTIFICATE OF LIABILITY INSURANCE 1 DATE 051/03/12 03112( IY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER 626535.830 United Agencies, Inc. (2) CA License #0252636 626577 -134 6 301 E. Colorado Blvd. Ste. 200 Pasadena, CA 91101 NAME; PHONE FAX (AIC No Elie I INC. No: ADDRESS: INSURERS AFFORDING COVERAGE NAIC oe Gleson INSURERA: Transportation Insurance Co. 20494 $ 300,00 INSURED Soul At Home - Tustin LLC 17612 E 17th Street INSURERB:Valley Forge Insurance Co. 20508 $ 2,000,00 Tustin, CA 92780 INSURER C $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRa LOC I�T F7 PRODUCTS - COMP/OP ASS $ 4,000,00 NSURER D $ INSURER E LIABILITY MY AUTO ALL OWNED SCHEDULED ALTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS INSURER F COVERAGES CERTIFICATE NLIMRER: RclaclnAl AIIIMncR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TY PE OF INSURANCE 05129/12 05/29113 LIMITS EACH OCCURRENCE $ 2,000,00 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE F� OCCUR X Business Owners X 3013144914 PREMISES Ee occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRa LOC I�T F7 PRODUCTS - COMP/OP ASS $ 4,000,00 $ AUTOMOBILE LIABILITY MY AUTO ALL OWNED SCHEDULED ALTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS aura .Stitt tj handy T� 1Y1 I Ee accident BODILY INJURY (Per person) $ Ix BODILY INJURY (Per accident) $ PRO ERTY DAMAGE (Per $ $ UMBRELLA LIAB EXCESSLIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORIPARTNEREXECTIVE Y� ANY PROPRE LI OFFICERMEMBER EXCLUDED? (Mandatory In NH) D" es, desc.Oe under CRP TI0 OF PERATI NS be. NIA 012469961 05129112 05129113 X WC S A K E. L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE- EAEMPLOYE $ 1,000,00 E. L. DISEASE - POLICY LIMIT 100000 DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Aftch ACORD 101, Addidonal Romania Schedule, a more spate la required) City of Santa Plaza , its officers, agents, employees, representatives, and volunteers are named as additional insured per the attached endorsement. City of Santa Ana Attn: Athena Martinez 20 Civic Center Plaza Santa Ana, CA 92702 ACORD 25 (2010105) SANTA -A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A4 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD