BACK TO NATIVES RESTORATION (BTN) -2011

Home Browse Search

tiiii vJ v CERTIFICATE OF LIABILITY IN5URANCE 03115111 OP ID: PC A`°R °' CERTIFICATE OF LIABILITY INSURANCE DATE 0'115/11 Y 03115111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). >RODUCER 626 -405 -8031 :hapman 626 -405 -0585 .Icense #0522024 1. O. Box 5455 lasadena, CA 91117 -0455 CONTACT NAMI PHONE FAX AlC No AIC No -MaL ADDRESS: PRODUCER gACKT -1 CUSTOMER a: INSURER(S) AFFORDING COVERAGE NAICp NSURED Back to Natives Restoration PO Box 6539 Irvine, CA 92612 -6539 INSURER A: NIAC 10023 INSURER B: INSURERC: D: EACH OCCURRENCE -INSURER E A -INSURER INSURER F: X ^nvcoAi ecRTIFIi NIIMRI REVISION NUMBER: THIS IS TO CERTIFY THAT 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VTR R TYPE OF INSURANCE POLICY NUMBER MILD Y DY" MMILDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 201021765NPO 10101110 10101111 PREMISES Ea occurrence) $ 500,00 MED EXP (Any one person) $ 20,000 CLAIMS -MADE OCCUR PERSONAL T ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO S 2,000,00 S POLICY J LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per acaden0 S ALL OW NED AUTOS PROPERTY DAMAGE (Per t A SCHEDULED AUTOS HIRED AUTOS 20102176SNPO 10101110 10101111 X X $ NON -OWNEDAUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS-MADE DEDUCTIBLE $ S RETENTION S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE❑ T WC STATU- OTH- R IT ER E. L. EACH ACCIDENT S R/M OFFICEEMBER EXCLUDED? (Mandatory In NN) NIA E. L. DISEASE - EA EMPLOYE $ E. L. DISEASE - POLICY LIMIT S / es, deacdbe under DESCRIPTION OF OPERATIONS trelmv A Sexual Abuse 201021765NPO 10/01110 10101111 Occurrent 1,000,000 Aggregate 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Mach ACORD 101, AddNlonel Remarks Schedule, If mom space Ie required) Re: Use of City Premise at 600 E. Memory Lane, Santa Ana, CA 92705. The City A Santa Ana, Its officers, employees, agents and volunteers are named additional insured with respect to the operations of the named insured per he attached CG 2026 endorsement. Such insurance is primary and CITYSAI gPPROVED AS TO FOF The City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 9 aura Sti Sheedy Assistant City Attorney SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 1988 -2009 ACORD ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD to CoTC Li /I,� III All rights reserved.