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A CERTIFICATE OF LIABILITY INSURANCE
<br />DATE ( 02J10/2014 0/2014
<br />PRODUCER
<br />STATE SURANCE - JOHN LUITHLY
<br />THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION
<br />ONLY AND .CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />16277 1tANYON RD STE F
<br />IRVINE, CA 92618-4011
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />TYPE OF INSURANCE
<br />POLICYNUMBER
<br />POLICYE FECTIVE
<br />DATE MMIDDIYY
<br />INSURERS AFFORDING COVERAGE
<br />MAIC #
<br />INSURED
<br />INSURER State Farm General insurance Com an 25151
<br />25151
<br />INSURER B: State Farm Mutual Auto Insurance CoMpany 25178
<br />08/25/13
<br />ELIZABETH M KILEY INC
<br />INSURER C: State Farm Fire and Casualty Company 25143
<br />PREMISES Ea occurrence $ 2,000,000
<br />^
<br />DBA KILEY COMPANY •-yi-/7'J
<br />INSURER O:
<br />2681 DOW AVE STE EJ1t7e- 0� I
<br />p
<br />TUSTIN, CA 92780-7244' i O
<br />INSURER E:
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />14SRADUL
<br />LTR
<br />INSRD
<br />TYPE OF INSURANCE
<br />POLICYNUMBER
<br />POLICYE FECTIVE
<br />DATE MMIDDIYY
<br />POLICY—EX'(—RATION
<br />DATE MMMDIYY
<br />LIMITS
<br />A
<br />X
<br />GENERAL UABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />92-YG-5250-7 G
<br />08/25/13
<br />08/25/14
<br />EACH OCCURRENCE $ 2,000,000
<br />PREMISES Ea occurrence $ 2,000,000
<br />MED EXP ereperson) $ 5,000
<br />DLAIMSMADE OCCUR
<br />PERSONAL &ADV INJURY $ 2,000,000
<br />X BLDG COV- $49,500
<br />X CONT COV- $55,700
<br />GENERAL AGGREGATE $ 4,000,000
<br />GENLAGG-REGATELUTAPPLESPER
<br />PRODUCTS-COMPIOPAGG $
<br />PRO.
<br />POLICY JECT LOC
<br />B
<br />X
<br />AUTOMOBILE
<br />LIA91LITY
<br />085 9537-BOI-75J
<br />02/01/14
<br />08/01/14
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $
<br />ANY AUTO
<br />2014 MERCEDES
<br />X
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />WDDLJ7DB5EA100763
<br />BODILY INJURY $ 1,000,000
<br />(Per person)
<br />BODILY INJURY $ 1,000,000
<br />(Per evident)
<br />X
<br />X
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />PROPERTY DAMAGE $ 1,000,000
<br />(Per avidonp
<br />X
<br />COME, DED - $500
<br />iX
<br />COLL DED - $500
<br />GARAGE LIABILITY
<br />AUTO ONLY -EA ACCIDENTS
<br />,
<br />OTHER THAN EAACC $
<br />ANYAUTO
<br />7
<br />AUTO ONLY:
<br />AGG $
<br />A
<br />X
<br />ExGESSAMISBELLA
<br />LIABILITY
<br />75 -CD -2498-7 G
<br />08/02/13
<br />08/02/14
<br />EACH OCCURRENCE S 5,000,000
<br />AGGREGATE S
<br />OCCUR ElCLAIMS MADE
<br />$
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />C
<br />"WORKERS COMPENSATION AND
<br />EMPLOYERS` LIABILITY
<br />ANY PROPRIETORIPARTNEWEXECUTNE
<br />OFFICER)MEMSER EXCLUDED?
<br />92-CG,H685-S F
<br />09%Ol 13
<br />/
<br />09/01/14
<br />X WCSTATU- OTH-
<br />TORY LIMITS ER
<br />E. L. EACH ACCIDENT $ 1,000,000
<br />EL DISEASE - EA EMPLOYEE $ 11000,000
<br />R yes, describe under
<br />SPECIAL PROVISIONS CeIOH
<br />E.L. DISEASE -POLICY LIMIT' $ 1,000,000
<br />A
<br />( OTHER
<br />DESCRIPTION OF OPERATIONS I LOCATIONS A VEHICLES f* T. Y D R N ! PECIAL PROVISIONS
<br />Xv4lazula
<br />Stltt—hC6
<br />HO
<br />CANCELLATION
<br />ADDITIONAL INSURED:
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE WE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 GAYS WRITTEN
<br />CITY OF SANTA ARTA
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
<br />ITS OFFICERS, EMPLOYEES & AGENTS
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />C/O ROSS ANNEX
<br />REPRESENTATIVES. ,1.--
<br />AUTHORIZED REPRES NTATIVE
<br />20 CIVIC CENTER PLZ
<br />JOHN LUITALYj
<br />SANTA ANA, CA 92701-4058
<br />ACUHU 2b (ZUUVUU) I ne teyinuauun uuuccs "u,"—pp—,— ...,...,p..... _ _ _.
<br />132849 03-13-2007 N All rights reserved
<br />
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