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OP ID: MS �acoleo- CERTIFICATE OF LIABILITY INSURANCE \� DATE (MM /DD/VVVV) 06/1 O/1 1 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 pollcy(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 endorsements . PRODUCER 626 - 535 -8300 United Agencies, Inc. (2) CA License #0252636 826 -577 -1 346 301 E. Colorado Blvd. Ste. 200 Pasadena, CA 91101 Joe Gieson CONTACT PHONE FAX ac No E :t � ac No E -MAIL ADDRESS: PRODUCER SOULA -1 CUST MER ID #: INSURERS AFFORDING COVERAGE NAIC p EACH OCCURRENCE INSURED Soul At Home - Tustin LLC INSURER A : TranS ortation Insurance Co. 20494 17612E 17th Street 167 -002 INSURERe: National Fire Insurance Co. 20893 Tustin, CA 92780 N- 2008 - INSURER C INSURER D $ 4,000,00 GEN'L AGGREGATE POLICY INSURER E PRODUCTS - COMP /OP AGG $ INSURER F _ _ $ COVERAGES CERTIFICATE NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE SANTA -A POLICY NUMBER MM /DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR X Business Owners X 3013144914 05/29/11 05/29/12 EACH OCCURRENCE $ 2,000,00 PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 1D,DD PERSONALSADV INJVRY $ © 1988 -2009 ACORD CORPORATION. All rights reserved. GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO LOC PRODUCTS - COMP /OP AGG $ _ _ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS P��t,v �� .ly �- �,) yZ -\ \ COMBINED SINGLE LIMIT (Ee accitlenl) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accitlenq $ PROPERTY DAMAGE (Par accitlant) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE ---� ti11CC ��. � - �a�l �" sully �Sy \SC \nC c.G�,Y y \�' (`yl li)T -�A� -- EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ —� � —�- B WORKER3 COMPENSATION AND EMPLOYERS' LIABILITY ANV PROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4012489981 05/29/11 D$/29/12 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,DDD,DD E.L. DISEASE - EA EMPLOYEE $ 1,DDD,DD E_L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ARaeh ACORD '10'1, Adtlltlonal Remarks ScheOUle, IT more space la requl red) City of Santa Ama, its officers, agents, employees, representatives, and volunteers are named as additional insured per the attached endorsement. CERTIFICATE HOLDER CANCELLATION SANTA -A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn- Athena Martinez ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESE�NT/V�A /TIIVE © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD