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AgWFgrMCERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDtYYYY) <br />09/29/2016 <br />PRODUCER &J <br />STATE( SURANCE - JOHN LUITHLY <br />16277 CANYON RD STE F <br />IRVINE, CA 92618-4011 <br />I dft I <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 />NAIC # <br />INSURED <br />ELIZABETH M KILEY INC <br />DBA KILEY COMPANY <br />2151 MICHELSON DR STE 205 <br />IRVINE, CA 92612 <br />INSURERA: State Farm General Insurance Company 25151 <br />25151 <br />INSURER 8: State Farm Mutual Auto Insurance Company 25178 <br />AUTHORIZED REPRESEr]VF <br />INSURER C: State Farm Fire and Casualty Company 25143 <br />INSRD <br />INSURER 0: <br />POLICY NUMBER <br />INSURER E <br />DATE (MM/DD[YY) <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 />INSR <br />AD011 <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 REPRESEr]VF <br />LTR <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE(MMIDD/YY <br />DATE (MM/DD[YY) <br />LIMITS <br />A <br />X <br />GENERAL LIABILITY <br />92 -C9 -V665-7 <br />06/01/16 <br />06/01/17 <br />EACH OCCURRENCE <br />s 2,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />D <br />OAMAUETTRERTEce) <br />PREMISES�occurren <br />$ 2,000,000 <br />CLAIMS MADE FXIOCCUR <br />MED EXP An one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 2,000,000 <br />GENERAL AGGREGATE, <br />S 4,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER <br />PRODUCTS-COMPIOPAGG <br />$ <br />PRO• <br />.7 POLICYF—] JECT LOC <br />7 <br />B <br />X <br />AUTOMOBILE <br />LIABILITY <br />085 9537 -B01 -75J <br />08/01/16 <br />02/01/17 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />ANY AUTO <br />2014 MERCEDES <br />BODILY INJURY <br />(Per person) <br />----- <br />—X <br />11 1,000,000 <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />WDDLJ7DB5EA100763 <br />BODILY INJURY <br />(Per accident) <br />$ 1,000,000 <br />X <br />• <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />$ 1,000,000 <br />• <br />X <br />COMP DED - $500 <br />COLL DED - $500 <br />AGE LIABILITY <br />AUTO ONLY - EA ACCfDENT <br />$ <br />OTHER THAN _EA ACC <br />$ <br />ANY AUTO <br />S <br />AUTO ONLY: <br />AGG <br />A <br />X <br />EXCESSIUMBRELLA LIABILITY <br />75 -CD -2498-7 <br />08/02/16 <br />06/02/17 <br />EACH OCCURRENCE <br />S 5,000,000 <br />=j OCCUR FJ CLAIMS MADE <br />AGGREGATE <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROP RIETORIPARTNER]EXECUTIVE <br />92 -CX -L783-0 <br />09/01/16 <br />09/01/17 <br />XrH_ <br />TORY LIMITS :R <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />!LLDISEASE-EA EMPLOYEE <br />$ 1_000,000 <br />OFFICER/MEMBER EXCLUDED? <br />If yyas, describe under <br />ECIAL PROVISIONS belcw <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />CERTIFICATE AND ADDITIONAL INSURED COVERS AGREEMENT #A-2015-155 AND A-2011-0 8 <br />r' '7111�-- <br />­ ­ -_ ­* . ­­ ...... . ........... <br />REVREWED BY� EUNICE HEREDIA (PG /OF <br />ADDITONA-L INSURED: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 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. 9=11 a <br />AUTHORIZED REPRESEr]VF <br />20 CIVIC CENTER PLZ <br />SANTA ANA, CA 92701 <br />JOHN LUITHLY <br />AGORD 25 (2001/UU) I ne registration notices inaica(e ownersnip OT fine MarKS Dy meir re5pu(;tivy uwflvls r 1Jf_%IwWrNw %1yrNrwr_1p% 1 lwll I V001 lcvvl <br />132849 03-13.2007 All rights reserved <br />