KARMINA RESTAURANT AND GRILL - 2010

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A ca CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08-19-2010 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 policy(ies) 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 endorsement(s). PRODUCER FIESTA AUTO INSURANCE CENTERS 31721 RIVERSIDE DRIVE LAKE ELSINORE CA 92530 CONTACT NAME: PHONE 951-245-7624 FAC No: 951-245-7658 E-MAIL ADDRESS: PRODUCER C O ER ID #: INSURERS AFFORDING COVERAGE NAIC# INSURED KARMINA RESTAURANT 515 N. MAIN ST SUITE B SANTA ANA CA 92701 INSURER A: LLOYDS OF LONDON INSURANCE CO INSURERS: SOUTHERN INSURANCE CO INSURER C : INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL I R SUER POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Z OCCUR FQMFT 08/16/2010 08/16/2011 EACH OCCURRENCE S 1,0001000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL &ACV INJURY $ 11000,000 A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 11000,000 PRO LOC POLICY JECT $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea accident) —' $ ANY AUTO BODILY INJURY (Per person) $ - ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A WSI00044454- APP D AS F FORM WC STATU- OTH- MI E.L. ETCH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 11000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S 1,000,000 EPH FLETC ER DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Aft h ACORD dtli Iona em s I , if more space is required) CERTIFICATE HOLDER ADDED AS ADDITIONAL INSURED ONLY AS THEIR INTEREST MAY APPEAR UrK 111-it A I t MULutK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDR,fARES TATIVE ' c ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD