Laserfiche WebLink
CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/014 <br />oa/z71zp14 <br />PRODUCER <br />STATE FARM INSURANCE - JOHN LUITHLY <br />16277 LAGUNA CANYON RD STE F <br />IRVINE, CA 92618-4011 <br />AL <br />THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE. DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIL # <br />INSURED <br />ELIZABETH M KILEY INC <br />DBA KILEY COMPANY <br />2661 DOW AVE STE E <br />TUSTIN, CA 92780-7244 <br />INSURERA State Farm. General Insurance company 2$151 <br />25151 <br />INSURER B: State Farm Mutual Auto Insurance Company 25178 <br />AUTHORIZED REPRESENTATIVE <br />INSURERC:State Farm Fire and Casualty Company 25143 <br />(Nets <br />INSURER D: <br />POLICY NUMBER <br />INSURER E: <br />DATE MMIOD(Y) <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 />Nits <br />ADD4 <br />ITS OFFICERS, EMPLOYEES & AGENTS <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />AUTHORIZED REPRESENTATIVE <br />UR <br />(Nets <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE(MM/DDP/Y <br />DATE MMIOD(Y) <br />LIMITS <br />A <br />X <br />GENERAL LIABIDTY <br />92-YG-5250.-7 <br />08/25/14 <br />08/25/15 <br />EACHOCCURRENCE 2,000,000 <br />PREMISES;jEaoccure $ 2,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR <br />MED EXP An one person)$ 5,000 <br />X BLDG COV- $50, 400 <br />_ <br />PERSONAL & ADV INJURY $ 2,000,000 <br />X CONT COV- $56,800 <br />GENERAL AGGREGATE $ 4,000,000 <br />OENLAGGREGATEUMRAPPUESPER, <br />PRODUCTS-ODMRSPAGG <br />PRO. <br />R R <br />POLICY JECT LOC <br />B <br />X <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />085 9537-BOI-75 <br />2014.MERCEDES <br />08/01/14 <br />02/01/1$ <br />COMBINED SINGLE LIMIT <br />(Ea acclden0 $ <br />BODILY INJURY <br />(Per parson) $ 1, QOfl, 000 <br />X <br />ALLOWNEDAUTOS <br />SCHEDULED AUTOS <br />WDDLJ7DB5EA <br />ED iQF <br />R <br />BODILY INJURY $ 1,000,000 <br />(Per accident) <br />X <br />X <br />HIRED AUTOS <br />NON•OWNEDAUTOS <br />X <br />COMP DED — $500 <br />PROPERTY DAMAGE <br />(Per accidem) $ 1, 000, 000 <br />T <br />LOLL DED — $500 <br />GARAGELIASILITY <br />ISta <br />t ty Attarn <br />y <br />AUTO ONLY—EAACCIDENT $ <br />OTHERTHAN EAACC $ <br />ANY AUTO <br />AUTO ONLY: <br />AGO <br />A <br />X <br />EXCESSIUMBRELLALIABILITY <br />75—CD-2498-7 <br />08/02/14 <br />08/02/15 <br />EACH OCCURRENCE $ 510001000 <br />AGGREGATE $ <br />OCCUR CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />,$ <br />RETENTION $ <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY <br />92—CG—A4.04-7 <br />09/01/14 <br />09/01/15 <br />X WCSTATU- OTH- <br />TORYLIMITS CER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />ANY PROPMETORIPARTNER/EXEGUTIVE <br />OFFICERIMEMBER EXCLUDED't <br />H Yes,descdbe under <br />SPECIAL PROVISIONS below <br />ILL DISEASE -EAEMPLOYEE $ 1,000,000 <br />EL DISEASE - POLICY LIMIT $ 1'00.0,000 <br />A <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS <br />CERTIFICATE HOLDER CANCELLATION <br />ADDITIONAL INSURED: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 30 DAYS WRITTEN <br />CITY OF SANTA ANA <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. <br />AUTHORIZED REPRESENTATIVE <br />20 CIVIC CENTER PLZ <br />SANTA ANA, CA 92701-4058 <br />JOHN LUITHLY <br />AUUKU 4D (LUV IIUD) I Ile rBgl$UHIIOn nonce$ InalcaIG OWn8TSnlp OT me marKs Dy [nelr respective Owners KFAGUKU UVKYUKA I RUN IUUU, ZOO <br />132849 03-13-2007 All rights reserved <br />