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` �� -0 <br />A CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/(YYY) <br />08-17-2010 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE 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 CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />FIESTA AUTO INSURANCE CENTERS <br />31721 RIVERSIDE DRIVE <br />LAKE ELSINORE CA 92530 <br />CONTACT <br />NAME: <br />PHONE A/C 951-245-7624 AC951-245-7658 <br />o <br />E-MAtL <br />ADD <br />PRODUCER <br />CUSTOM ER ID : <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />KARMINA RESTAURANT <br />515 N. MAIN ST <br />SUITE B <br />SANTA ANA CA 92701 <br />INSURER A: LLOYDS OF LONDON INSURANCE CO <br />INSURER B : <br />INSURERC: <br />INSURER D <br />INSURERE: <br />INSURER F : <br />CAVFRAGFS CFRTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />AINSRDDL <br />SUBR <br />POLICYNUMBER <br />MMIDDIYYYY <br />MMIDD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIALGENERALLIABILITY <br />FQMFT <br />08/16/2010 <br />08/16/2011 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMA E TO ENT <br />PREMISES Ea occurrence <br />$ 50,000 <br />CLAIMS -MADE 7 OCCUR <br />MED EXP (Any oneperson) <br />$ 51000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />A <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'LAGGREGATELIMITAPPLIESPER: <br />PRODUCTS -COMP/OPAGG <br />$ 1,000,000 <br />S <br />PRO- <br />POLICY JECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />Apt <br />P OVED AS <br />FORM <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />NON -OWNED AUTOS <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAR <br />HCLAIMS-MADE <br />OCCUR <br />N <br />Y <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />$ <br />$ <br />RETENTION $- <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />AND EMPLOYERS' LIABILITY Y / NW <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />N / A <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEN <br />S <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />RESTAURANT WITH NO SALES OF ALCOHOL BEVERAGES WITH TABLE SERVICE <br />TE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLMY-2RROVISIONS. <br />AUTHORIZED <br />C 01988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />