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Policy Number: <br />Date Entered: 1 n is inn, n <br />'4? RO CERTIFICATE OF LIABILITY INSURANCE <br />1 DATE <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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms 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 />WIT <br />Adams Avenue Insurance A <br />enc N <br />C, <br />ndi OT <br />g <br />y PH <br />ONE <br />P <br /> <br />License # 0756665 (8 <br />77)250-8397 <br />A No,(866)832-4186 <br /> <br />9114 Adams A <br />#144 MAa .cindiQAdamsAveZns.com <br />ve, PRODUCER <br /> CUSTOMER C <br />Huntington Beach, CA 92646 <br /> INSURER(S) AFFORDING COVERAGE NAIL <br />INSURED <br />WRJ-GT LLC <br />db <br />1E <br />C <br />i <br />l INSURERA:Sequoia Insurance Company <br />, <br />a <br />ssergy <br />onsu <br />ng <br />t <br /> INSURER8:United States Liability Insurance Co <br />Jill Dominguez INSURER C : <br />235 E Broadway #520 <br /> <br />Lon <br />Bea <br />h <br />CA 90802 INSURER D <br />g <br />c <br />, INSURER E : <br /> INSURER F : <br />-- i+ nunmcr.: 11tVI51UN NUMBER: <br />rule Io TO ctr<ur¦ II'fAl THE rVLIG1E5 OF INSUHMIGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DCCUAIENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Be ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED <br />POLICIES By I HE HEREIN E T 0 A A TH - TERMS. EXCLUSIONS AND CONQ TONS OF SUCH LICIES. LIMITS A BEEN REDUCED BY AID CLAIMS, <br />INSR ADDL 9U8 POLICY EFF POLICY EXP <br /> <br />POLICY <br />M <br />LTR TYPE OF INSURANCE POLICY <br />NUMBER <br />INSR -9a <br /> GENERAL LIABILITY <br /> EACHOCCURRENCE S11000-000 <br />A I CON1MERCIALGENERALUA61LITY X ENTED <br /> SBP212192-3 9/1/2010 9/1 Oil PREMISES Ea occurrence $ 300,000 <br /> CLAIMS-MADE <br />OCCUR <br />I> <br />O F <br />MEDEXP An One Crson <br />$ 10,000 <br /> D Y <br />S <br />I PERSONAL a ADV INJURY $ <br />l <br />d <br /> ?(D E <br />?O? <br />? inc <br />u <br />ed <br /> ' • <br />.t•1A' GENERAL AGGREGATE $ 2 <br />000 <br /> <br />GENLAGGREGATE LIMIT APPLIES PER: <br /> <br />G- <br /> <br />K <br />PRODUCTS - COMPIOP AGE; , <br />,000 <br />$2,000,000 <br /> POLICY P"0. LOC 1 C <br />1 $ <br /> AUT OMOBILE LIABILITY <br />t A110" <br />City COMBINED SINGLE LIMIT <br />$ <br />A ANYAUTO X Assistan (Ea acdden) 1,000,000 <br /> BODILY INJURY (Per person) S <br /> ALL OWNED AUTOS <br /> <br />SCHEDULEDAUTOS BODILY INJURY (Per accident) $ <br /> <br /> <br />HIREDAUTOS <br /> <br />SBP21219201 <br /> <br />9/2/2010 <br /> <br />9/1/2011 <br />PROPERTY DAMAGE <br />(Perauddent) _ <br /> <br />$ <br /> NON-OWNEDAUTOS SBP21219201 9/1/2010 9/1/2011 <br /> $ <br /> UMBRELLA LIA9 OCCUR EACHOCCURRENCE $ <br /> EXCESS LIAR CLAIMS•MADIE <br />AGGREGATE <br /> § <br /> DEDUCTIBLE <br />$ <br /> RETENTION $ S <br /> WORKERS COMPENSATION <br />ANDEMPLOYERS'UABILITY YIN WC STATU- OTH- <br />TORYLIKIIIS ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE <br /> OFFICERIMEMBER EXCLUDED? ? N1A E.L. EACH ACCIOENT S <br /> (Mandatory in NH) <br /> <br />flyas , describe under El DISEASE- EA EMPLOYEE $ <br /> DESCRIPTION OF OPERATIONS below E.L. 04SFASE - POLICY LJMIT S <br />B Professional SP1018037 7/13/2010 7/13/2011 Each Claim 11000,000 <br />Liability Aggregate 1,000,000 <br />DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Attach ACORD 161, Add,tlonal Remarks Schedule, if more space is required) <br />Certificate holder is additional insured, see attached <br />UhRlIFIGATE HOLDER _ I AWIWI I Arln.r <br />City of Santa Ana SHOULD ANY OF T ABOVE !DESCRIBED POLICIES BE R <br />20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br />I <br />®1988.2009 ACORD CORPORATION. All rights resarvad <br />na wr.v 40 1AUUVfUZJ) The ACORD name and logo are registered marks of ACORD <br />ProducedusingForms BassPlus software.www.Fo Soss.mmlmpreuNsPLUi"800-2oa-1877