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<br />'`�� °�° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYW)
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<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE POLICIES
<br />BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITVTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRO DS TI HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL 1 SURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the olicy, certain policies may require an endorsement_ A statement on this certificate does not confer rights to the
<br />I
<br />certificate holder in lieu of a dorsement 3" n I
<br />PRODUCER i _g$1 �f�aggSg
<br />�`�` ��� ->•°. �TL
<br />CONTACT
<br />a41vv NO
<br />�^�� � -
<br />(M) 951 - 676 -3020
<br />CA Lic nse #0252636
<br />27403 Ynez Rd., Ste. 110
<br />Eati�_— -- _______ ,(uc, >:
<br />E -MAIL
<br />ADDRESS:
<br />Temecula, GA 92591
<br />Ryan E. Hollander
<br />_ _ __ _ _ _ _ _ _ _ _ _ _ _
<br />PRODUCER ��-
<br />c�TOmerz to �,BELLB -1
<br />_______ _
<br />INSURER(SIAFFORDING COVERAGE NAIC#
<br />INSURED Chan H¢¢Yang
<br />wsuRERA:Landmark American Insurance
<br />Bell Building Maintenance Co.
<br />INSURERe:Preserver Insurance Company
<br />5170 Sepulveda Blvd_, #180
<br />_ - _. _. _.
<br />Sherman Oaks, CA 91403
<br />INSU RERC:
<br />1.000,00
<br />INSURER D
<br />INSURER E
<br />2,000,00
<br />INSURER F -
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVH ICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />(ERNS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS.
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana
<br />IN9R - - - -- - ADDL SUB POLICYEFF - POLICY E %P
<br />T TYPE OF INSURANCE � POLICY NUMBER MMIDDr,'YYY MMIDD /Yl'YY
<br />-
<br />LIMITS
<br />�- --
<br />GENERAL LIABILITY
<br />Santa Ana, GA 92702
<br />EACH OCCURRENCE $
<br />1.000,00
<br />A X COMMERCIAL GENERAL LIABILITY X X
<br />__
<br />LBA10026900 � 01H 0/11 01/10/12
<br />DANA
<br />I_PREMISE_5_(Ea omurranceJ $ _
<br />___ 100,00
<br />CLAIMS -MADE ': X OCCUR
<br />I
<br />� MED EXP (Any one person) $
<br />6,00
<br />_ - _. _. _.
<br />PERSONAL 8 ADV INJVR_Y_ _ $
<br />1.000,00
<br />I GENERAL AGGREGATE $
<br />2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />',
<br />PRODUCTS - COMP /OP AGG $
<br />1,000,00
<br />X POLICY PRO LOC
<br />I
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />I $
<br />- --
<br />(Ea accitlanl)
<br />I
<br />I ANY AUTO /�
<br />' I APPRO V �
<br />AA jj �� //��
<br />, /yS T�✓ FV )Z-
<br />DDILY INJURY (P r porson)_-
<br />$
<br />ALL OWNED AUTOS i
<br />BODILY INJURY (P r aa.cid rnJ
<br />$
<br />_ -- -
<br />,__- BCH FOULED AUTOS
<br />/'
<br />PROPERTY DAMAGE
<br />f
<br />I, � HIRED AUTOS '.
<br />/
<br />/_�f/ ✓ / 1 _
<br />Per acc!denl) _..
<br />$
<br />__.
<br />_`
<br />i C:.0 L`
<br />�.vy
<br />_ - -_ -�.
<br />NON -O WNED AVTOS LdUL
<br />I
<br />t
<br />__ _
<br />I
<br />t ALL ACLOrrIC
<br />1
<br />$
<br />UM BRELLA LIAB OCCUR
<br />'.
<br />I� EACH OCCURRENCE_.. $
<br />� - - -�
<br />��
<br />i E %CE33 LIAR CLAIMS -MADE
<br />I
<br />_
<br />i
<br />I
<br />AGGREGATE_ _ I $
<br />L__ DEDUCTIBLE
<br />_.
<br />_ - ' S. __
<br />___..
<br />I RETENTION S
<br />� I
<br />L. I $
<br />i WORKERS COMPENSATION �
<br />!WCC
<br />�
<br />__-
<br />X VJG STATU- 0TH -
<br />ANO EMPLOYERS' LIABILITY
<br />Y�
<br />TORY LI_MJLS___ _FR.
<br />_
<br />B ANY PROPRIETORIPART NER /EXECUTIVE ; N / A', DQU4991 D$/D2/11
<br />EXCLU DED4
<br />U5/02/12
<br />E L EACI1 ACCIDENT S
<br />-
<br />_ 1.UDO.DU
<br />OFFICER /MEMBER
<br />' (M antla[ory In NM) -
<br />E1 DISEASE EA EMPLOYEES _
<br />1.D��.DD
<br />/yes, tlascribe under '
<br />''� DESCRIPTION OF OPERATIONS below
<br />E L DISEASE - POLICY LIMIT S
<br />1.000.0U
<br />I
<br />-
<br />DESCRIPTION OF OPERATIONS I LOCATONS I VEHICLES AKxh ACORD tDt, Atltlitional Remarks Schedule, it mores space is required)
<br />Certi£cate holder, its oficere, agents, and employees are named as
<br />additional insured in reggards to General Liability, subject to actual policy
<br />terms and conditions• Entlorsement attached.
<br />This certificate supersedes the one issued 5 -3 -11.
<br />CITYOFS
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHDRIZED REPRESENTATIVE
<br />Santa Ana, GA 92702
<br />V 1- JOO-LVVJ MV VRa/ vv Rr-v Rr- ,I,v,�. RI, r,y„u ,cvc,�caa.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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