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03/04/2011 18.1E FAIL <br />lllcc xL Yaagtti "„ <br />THIS EpTTX7mErdzw caMCES YOUR POLICY. FLLFASE ftM IT <br />{ AT 12:01 A.M. LOCAL ETANDARD TIME } <br />POLICY NO: CLCM09463 <br />ISSUED TO: 0 rNTE'q.TAINkENT, INC. <br />AGENCY : LESTf R Kf.URMNSON AGENCY INC. / MAITLAND, M. <br />ISSUED SY: ? 001i CERTAIN UtOgRWRITERS AT LLOYD' S / LOWN <br />IN c?NSIL?F.f1mrm OF TEE PT{SMi(3t4 3753E7, _ IT is HERSBY <br />AGREED AND UNDEASTOO D TI A'T SUCH ADDZTIOM INSDREQ (S) IS / ARE NUEST <br />ADDED TO THIS POLICY, do/►JR BY SU@SE=14T CEATIVIC.?TF(5) OF INSURANCE <br />ISSUED BY LESTER ZhUMANSGN A(;ZNCY, INC. WILL SE AZ)09C1 ONLY AS THEM <br />INTERESTS MAY APPEAR. <br />IT IS AGREED THAT SUCH INS 7MNC AS IS AFFDADED BY TIE POLICY FOR <br />BODILY INJURY AND PROPERTY DA)MGE LIABILITY SfiP.I,I, ALSO APPLY TO ZAC11 <br />INTEREST NAMED PER CZRTXE7TCATE (S) or I'C vRANUE mum, AS AN n4sanD, <br />BUT ONLY IN RP..SPE. S TO LIABILITY ARISING CC ? OF THE DESIGNATED <br />PROMISES OF THE itiiiAZEP INSURED OR OPMTION (S) PERrORMED BY OR FOR THE <br />NAMED INSURED, THE INCLUSION OP SUCH ADDITIONAL INTEREST(S) SHALL NOT <br />OPERATE TO INCREASE THE COMPANY'S STATSD LIMITS OF LIABILITY. <br />IT IS AGREED THAT, IF THIS POLICY IS ISSOM TO A FIDUCIARY, <br />Tn SNSUR tCE ?AFFORDED BY THIS ENDORSr'WNT SHALL NOT APPLY TO ANY <br />EXECUTIVE OFFICER OR EMPLOYEE WITS RESPECT TO IN«T(TRY OR TO SICMESS, <br />DISEASE OR DEATH OF MOTHER EXECUTIVE OFFICER OR EMPLOYEE OF THE 3A"rSE <br />PtOYEfc INJMED IN THE COURSE OF SUCH EMP'L`f,-MSNT, <br />IT IS FORTHER AGREED THAT " 030 DAYS NOTICE OF CANCILILFiTION WILL BE <br />GTV.r*,l To THX ADOITZONAL INSO'MD(S) ZN THE ZVENT OF CANCELLATION OF <br />THIS POLICY, (1WI FSS OTHSRWISE STATED. <br />ADDITIONAL INSORE ; TH CITY' OF SANTA lam, I_'S OPTICERS, MMTS, A <br />EMPLOYEES; AGENTS. AND REPRESENTATIVES <br />EVENT DATE(S). AACR 07 - 15, 2011 <br />EVENT LOGATIOX: JEROME PARK, 726 S. CENTER, 9T2EET, SANTR ANA, CA <br />WARMNTED: 77 ANU AI,L ADDITIONAL INSUREDS A OED TO TiiaS <br />POLZCY by cv�RTIFTCAT"E OF INSCT'FtAwr- OR E1Y ENDORSEMENT, AS <br />STATED ABOVE, ARE ADDED ON OWC ,Y AS THEIR 1IMPIST MAY ALPIPW <br />IN RESPECTS TO TaZ 0921R.TION(S) &/OR ACTIVITY(S) PERPOft3ED <br />&/Oft PROV-1DED BY THE NAMED INSCREP(S) &/OR tT'S ftPLOYEE(S) <br />ONLY, AND FOR WHICH LIABILITY COV'ERAU IS AFFORDED &/OR <br />SCE(H=311) HERET AND/OR HERETO. <br />P R F M i U M C H A R G E D <br />19 CONSIDERTION CIE THE ?R"IW CHARVED, THE RB E AD77713m I1titsNEF <br />IS ADDED TO & MADE A PART OF THIS POLICY FOR THE S'1`XTP.17 EVENT DATE (S) <br />ONLY OR UNTIL EXPIRATION OF THE POLICY PERIOD CSWLY. <br />ALL METER TEP-48 AND CONDITIONS OP THIS POLICY REMAT <br />EN D 0 R S EMENT N UmB11vk 22 <br />3/04/11 X <br />ZP" 1 <br />i IIrG-3- $/05-&Sd-P-s�-ats�a J <br />AT -ER XALMA*tSOV Al'ZNCY INC. <br />Vv <br />EO/ZO 39Vd 196996VZ99 IO:ZO TTOZ/OI/£O <br />