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CO CA DI01 License No. OFO6675
<br />INSURED
<br />Phase H S Serns
<br />dba PAR�
<br />4350 Von Karman Ave., Ste 100
<br />Newport Beach CA 92660
<br />rim
<br />........ . .
<br />COVERAGES CERTIFICATE NUMBER' 20976202
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF lNSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY FE—FOOD
<br />INDICATED. NOTMTHISTANDING ANY REQUIREMENT, TERM OR CONDITION
<br />OF ANY CONTRACT OR OTHER DOCUMENT VOTH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR IMAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POL01ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL)MMS.
<br />IN . SR
<br />LTIR TYPE Or- INSURANCE IN POLICY NUMSER
<br />POUCYIEFF
<br />K I � I " j I Yyy LIMITS
<br />A COMMERCIAL GENERAL LIABILITY 72SBAAC2429
<br />51812,014 5/812015 EACH OCCURRENCE $ $2,000,000
<br />ICLOMMS-MADE 17, OCCUR
<br />$1 X0,000
<br />ME2 lalL{An)� one pe aorq S $10,000
<br />V URY 0000
<br />PERSONAL & All INJ S $2,�010
<br />r;E.N1 AOGREGATE UMIT APPLES PER:
<br />qENERAL AGGREGATE $ $4,000,000
<br />PRO.
<br />POLICY EIDECT E LOC
<br />54,000,000
<br />PRODUCTS - COMP OP AGG $ -
<br />OTHER
<br />$
<br />A
<br />AUTOMOBILE
<br />UAWLaY
<br />72SBAAC2429
<br />518/2014
<br />515,+`2015
<br />nr4l'AED g"NGLE LIMIT
<br />$2000,000
<br />, ANY AUT O
<br />800LYiNJURY(Perperqon)
<br />$
<br />BOWLY INJURY (Pew accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />--I,, -
<br />AUTO's AUTOS
<br />NON-OWNED
<br />HiRED AUTOS AUTOS
<br />P
<br />$
<br />UMBRELLA UAS OCIDUR
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LIAS CLiMMS-MADE
<br />AGGREGATE
<br />�D E D�RET F NTJO N $
<br />$
<br />WORKERS COMPENSATION
<br />p5p, ofl+
<br />ASFA'l "T
<br />AND EMPLOYFRTUABILITY YIN
<br />ANY PR0PRNETOPJPAPTNEPJEXECUTWE
<br />E,L, IEACH AMPENT
<br />$
<br />0FRCERM,tEMBER EXCLUDE El
<br />(Mandatory In NH)
<br />MIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />0 g, desctibe uncler
<br />0 S wRIPTION OF OPERA=NS below
<br />E.L. DISEASE - POUCY LIMIT
<br />$
<br />B , Prolessk,)nal I uabIflty LDUSAI 04508
<br />7/3012014 7/30(2015 P(-,V Cl inn $2,0010,000
<br />Aggregate: $2,000,0010,
<br />'N
<br />- 0,ESCRIPT9ON; 07; ERA;;NS LOCATIONS I VEHICLES lACORD 101, AddiVonal Remarks Schedule, may be attached if more space Is requIred)
<br />Projects as on r1le With the Insured including but not limited to those usuall to the
<br />insured's operations/PARS Supplementary Refi here nt Plan,
<br />The City of Santa Ana, its offidals, employees and volunteers are named as additional insureds on the general fiaNfit%ag I' R§ee attached
<br />I P ,( )RM
<br />endorsement.
<br />A,P 1119YED x
<br />'U
<br />Wyd
<br />7
<br />CERTIFICATIE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, N07110E WILL BE DELIVERED IN
<br />Attn. Executive Director of Personne� Services
<br />Attn.
<br />ACCORDANCE WrrH THE POLICY PROVISION&
<br />20 Center Raze
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATiVE
<br />it Mike Christian
<br />@ 19188-2014 AC10RD CORPORATION, All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of AC RID
<br />�!ERT IT'D.: '0570,0,7 ;tp%'N alb_ , :b?_: _i' 7j21 /..mN 1.a,'„r „IR.) AM va r 4, 1 Jf i.,-,
<br />
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