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,4coR©® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/20/2013 PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION STATE FARM INSURANCE - JOHN LUITHLY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16277 LAGUNA CANYON RD STE F HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR IRVINE, CA 92618-4011 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SANTA ANA, CA 92701-4058 LTR INSRD INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:State Farm General Insurance Company 25151 25151 INSURERB:State Farm Mutual Auto Insurance Company 25178 X ELIZABETH M KILEY INC INSURERC:State Farm Fire and Casualty Company 25143 08/25/12 DBA KILEY COMPANY INSURER D: 2681 DOW AVE STE E p TUSTIN, CA 92780-7244 Q INSURER INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDT C/O ANNEX, ROSS REPRESENTATIVES. POLICY EFFECTIVE POLICY EXPIRATION SANTA ANA, CA 92701-4058 LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD LIMITS A X GENERAL LIABILITY 92-YG-5250-7 G 08/25/12 08/25/13 EACH OCCURRENCE $ 2,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE2,000,000 PREMISES Ea occurrence $ CLAIMS MADE FIOCCUR MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 2,000,000 X BLDG COV- $47,800 X CONT COV- $53,700 GENERAL AGGREGATE $ 4, 000, 000 GENLAGGREGATE UMIiAPPLIES PER : PRODUCTS - COMP/OP AGG $ PRO - POLICY JECT LOC B X AUTOMOBILE LIABILITY ANY AUTO 085 9537-BOl-75J 2011 MERCEDES 02/01/13 08/01/13 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 1,000,000 X ALL OWNED AUTOS SCHEDULED AUTOS WDDHF7CB4BA417471 BODILY INJURY $ 1, 000, 000 (Per accident) X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ 1, 000, 000 X COMP DED - $500 X COLL DED - $500 GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ A X EXCESS/UMBRELLALIABILITY 75 -CD -2498-7 G 08/02/12 08/02/13 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ OCCUR FICLAIMS MADE $ DEDUCTIBLE $ RETENTION $ C WORKERS ORKS SCOMPPEELSTAYIONAND 92-BZ-PO52-7 F 09/01/12 09/01/13 X WCSTATULMT oR TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L.DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS APPROVED AS TO FORM CERTIFICATE HOLDER —GANCELLATION ADDITIONAL INSURED: Laura 51.11,11. Mlie--.T A,Ssistant City AtLOrne, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CIT OF SANTA ANA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IT'S OFFICERS, EMPLYERS & AGENTS IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR C/O ANNEX, ROSS REPRESENTATIVES. 20 CIVIC CENTER PLZ AUTHORIZED REPRESENTATIVE SANTA ANA, CA 92701-4058 JOHN LUITHLY M\i Vrll! Lu k4w 11vol r ne reyrsuauon notices rrrarcace ownersnip or cne marcs Dy melr respective owners VAI.UKLI L UKYUKAI IDN 75lifif, LUU/ 132849 03-13-2007 All rights reserved Q