|
141- A007-C-04-ooj
<br />ACQ CERTIFICATE OF LIABILITY INSURANCE
<br />PRODucrn (94911851-8800 b
<br />GSM Insurance Sarviceo
<br />Lic. 7OD25612
<br />10 Cc•rpo_at* Park #307
<br />QAtE �s1KMYYYY1
<br />8/21/2009
<br />19) 851-88']2 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORIVATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Irvinci CA 9263-. INSJRERS AFFORDING COVERAGE NRIC 4
<br />wsuprr i;f^rl L :V'311t 11.LS Inn Co
<br />Curbside, Inc. sl ^ R y Great Div -'de 17:3 Co
<br />500 S. Jefferson
<br />.
<br />F -aces _ .2 CA 92670
<br />COVERAGES
<br />•`IF : OLI•CIES OF i'J8U?AM10E-'_;S-ECI SELCi': HAVE EEc1.1 ISS_�EO "C 'NE •`JSURcC P:RR{"c� ?Bi3�E FGrc Hi FJL,.�?FA.UC h.GIC1TEC I'.G''f'1I'-•S'AN[2 by
<br />ANS RECUIttEA�tVf, 7F.iL! :rFa CC:NL]C[iGK OP ?.NY CL?tiTitACr i"R OTHER DOrUIr'E':"'Jdl''rI i�=3PE^T Tr, Y:N`'-•=1s CERT!>•1G1TE `.L��" eE +35JEC QR
<br />UA" :17RIA N, frF Jk5UR NCE AFF()R3Ea 9Y -HE r-CL:C'ES OESCRISFU-EEREIV IS SJ?:_CT T6ALL ?•HE TERRS.C-tlS. EXCLIUS'.CNS +4Nn CONDITIONS OrSjr,. j
<br />110..!.,kt.. ACii)'?E:LiA-_ UM SFMAI MAY HA,42 Lt J F ULCC_:S 8V f`A f C AIV
<br />--2 FGJC9 C+-LClSE 1\r'CY EXPIROTOr.
<br />LTR FYtnri,. -ra--..1.IMSUAw _, __... ..POIIL Y'N{,MaeER 41L!ti+firPU+YvYY". CAT•: :uM1UC_YYYv+ _ __ L".1115_ _
<br />' I{ GCKeRAL LMDILIT'Y 1, COO, coo rr.u•� � o rt r L
<br />}C i- N}JUi:; .k + +=n¢iv''�. L.AUq � 1'• NFall'Fti F A � V s i;i0 . f.+OC
<br />GC �Xi CX, 14 *' 1 u2v_18:-L2 si23i200v ;
<br />8/23/2010 w+.ora ;~r,.rog« on) S 5,00'71
<br />�=N1. I•r;J�HI-;;AL1= _ I•.f - hcY_It5 f-?''.
<br />ea 1Ca:ca �E ��:2.urr
<br />X�aP�.alTc
<br />_ _ 1 All
<br />C1 S:1's.LC_L' •'.18'05
<br />X NIRT -, A,. T.•,
<br />i
<br />Cu -
<br />Cm:: 'a r h Cel ;
<br />l :u:l.
<br />tt +
<br />riAR AGE L•AU' L+T Y ;\,t L
<br />�••y aI F�
<br />13/23/2030 9/23/203::
<br />Fl;s:^,C;:r,L a A\:•c t.�,;Ety s 3, Oo o• I: u 0
<br />r.F!,ERA; A:::1RiilA r . r e; OCQ, Oa0
<br />FROxWCTs 2. 000, COO -
<br />�i�b'9IrICC5114CW,1 s .000.00
<br />i^e' ULLJtn"
<br />V J{'Lt (r
<br />fin• jr=c.rn,
<br />rA A:.C:L'<.VI t _�
<br />i
<br />Fl;s:^,C;:r,L a A\:•c t.�,;Ety s 3, Oo o• I: u 0
<br />r.F!,ERA; A:::1RiilA r . r e; OCQ, Oa0
<br />FROxWCTs 2. 000, COO -
<br />�i�b'9IrICC5114CW,1 s .000.00
<br />i^e' ULLJtn"
<br />V J{'Lt (r
<br />fin• jr=c.rn,
<br />rA A:.C:L'<.VI t _�
<br />L*SC RIP TI ON Cf- lkLKA IR.M I LU::AIWFJ5! VEPNC_LS 1 EXCL VIM S AL -3L -D BY ENUON SEME.JT/ SPECIAL PKZN)S. CVS
<br />Tliv` Cyn,wrAl habil%Zy pol.i/:y incl'.Ide3 tha :0Tf of RantA ACA, irFl nFfi,anr9, GCJp1Jy908, p7,�r�`. r,, yplUSL6vr9 Ort:
<br />ruproaen" ivies as adr1lt:,wial ir.5urtui K_LIl ragard Lo W.rk : viz:utnnd ::y oz on EJa!in_f o_zho Nacos :anuzad uhura COLT"Xod
<br />Ity xzLtton contract. "Except 1C days for ncnpaymenz. of pracicn
<br />CERTIFICATE HOLDER CANCELLATION
<br />may! � SHOULD ArJf' 7f Yn?k ADDLE OCEC7_6L_ PGLICk�6 dL CANC$LLBD tleFGR[T!i� E%P;RATij)f.
<br />U> y of Sbr,*;a Ara DATE Tki:REZF,T-fc3p_^Y
<br />DapartmQnt of Pub1:1C W;>rka NO"Ctl 101 fCfR1p.'CAT'E IIOLLE14NAMkD TC'E!!1 LEI T,PW - ___aA sis wwWwrrFN�
<br />.'Lttn: Chr;.rsty Mendip
<br />20 Civ_c Canter Plaza, M-21 �
<br />Santa lura, CA 92702 I{
<br />AWNDRIZEO REPRESENTATIVE _ r
<br />ACORD 25 (2009101> Q 1908.2002 ACORD CORPORATION All rights resorvud.
<br />INS025 (mQ)"' The ACORD name and 'ago are registered marks of ACCORD
<br />Aw
<br />n
<br />E 11 .• 11 •,CM.:71iE.k.-
<br />r
<br />_ :)Cta,K
<br />M: 14NIK04
<br />•+ 5;
<br />I x
<br />AND EM?LOYFRS' l.Atlr
<br />l! Y!/:
<br />FG^Y L19'S
<br />%' VS
<br />cit '
<br />FVr [1RCi1riCFC0^lA NT.✓.^:rtt•vF_ I
<br />i ACI, A CCN-
<br />t'JUJOUC
<br />(N�ndalerf In lM .�rC.a15:235"-:)
<br />8/23/2309
<br />8/23/20_3
<br />NSCA5 C4 E) Lv!E
<br />t
<br />1 070, QGc•
<br />Yw1,__vx n`n
<br />i
<br />IC - .
<br />h. F`f» 1,T5�^IS auk n __..
<br />_
<br />. >_.: +t'U1SF. , (i::y
<br />W, T 1
<br />:
<br />1 , 00n 00!11
<br />A
<br />jorrLRContractcrs ?CQo o2va_vl_1,
<br />I
<br />.9/23!2009
<br />I9/23/2CIC
<br />iaca Dxuscua
<br />S
<br />_
<br />!,0.^.O,OOC
<br />Po11LL_en
<br />Ao:,eooa_e
<br />$
<br />2.0.0,000
<br />L*SC RIP TI ON Cf- lkLKA IR.M I LU::AIWFJ5! VEPNC_LS 1 EXCL VIM S AL -3L -D BY ENUON SEME.JT/ SPECIAL PKZN)S. CVS
<br />Tliv` Cyn,wrAl habil%Zy pol.i/:y incl'.Ide3 tha :0Tf of RantA ACA, irFl nFfi,anr9, GCJp1Jy908, p7,�r�`. r,, yplUSL6vr9 Ort:
<br />ruproaen" ivies as adr1lt:,wial ir.5urtui K_LIl ragard Lo W.rk : viz:utnnd ::y oz on EJa!in_f o_zho Nacos :anuzad uhura COLT"Xod
<br />Ity xzLtton contract. "Except 1C days for ncnpaymenz. of pracicn
<br />CERTIFICATE HOLDER CANCELLATION
<br />may! � SHOULD ArJf' 7f Yn?k ADDLE OCEC7_6L_ PGLICk�6 dL CANC$LLBD tleFGR[T!i� E%P;RATij)f.
<br />U> y of Sbr,*;a Ara DATE Tki:REZF,T-fc3p_^Y
<br />DapartmQnt of Pub1:1C W;>rka NO"Ctl 101 fCfR1p.'CAT'E IIOLLE14NAMkD TC'E!!1 LEI T,PW - ___aA sis wwWwrrFN�
<br />.'Lttn: Chr;.rsty Mendip
<br />20 Civ_c Canter Plaza, M-21 �
<br />Santa lura, CA 92702 I{
<br />AWNDRIZEO REPRESENTATIVE _ r
<br />ACORD 25 (2009101> Q 1908.2002 ACORD CORPORATION All rights resorvud.
<br />INS025 (mQ)"' The ACORD name and 'ago are registered marks of ACCORD
<br />Aw
<br />
|