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DATE(MM/OD/YYYY) <br />a4C� '° CERTIFICATE OF LIABILITY INSURANCE 02/09/2012 <br />PRODUCER <br />Maguire Insurance Agency, Inc. <br />27101 Puerta Real Suite 200 <br />Mission Viejo, CA 92691- <br />i877)438 -7459 <br />INSURED <br />Chihiro Sano <br />106 Yorktown Ln <br />Costa Mesa, CA 92626- <br />COVERAGES <br />THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURER B: <br />INSURER D: <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 CERIFICATION 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 />ADD'L <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />LTR <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE (MM /DD/YYYY) <br />DATE (MM/DD/YYYY) <br />LIMITS <br />A <br />X <br />GENERAL LIABILITY <br />PHPK803569 -000 <br />12/08/2011 <br />12/08/2012 <br />EACH OCCURENCE <br />$1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$100,000 <br />% COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE 5 OCCUR <br />MED EXP (Any one person) <br />$2,500 <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />X PROFESSIONAL LIABILITY <br />GENERAL AGGREGATE <br />$3,000,000 <br />PRODUCTS— COMP /OP AGG <br />$3,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />nX POLICY PROJECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />(EA accident) <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY— EA ACCIDENT <br />OTHER THAN EA ACC <br />ANY AUTO <br />AUTO ONLY: AGG <br />EXCESS / UMBRELLA LIABILITY <br />EACH OCCURENCE <br />OCCUR F_� CLAIMSMADE <br />,� h' , <br />J'E' i <br />4. �� <br />AGGREGATE <br />DEDUCTIBLE <br />RETENTION <br />9 <br />WORKERS C MPENSATION AND <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR /PARTNER /EXECUTIVE <br />-- <br />_. _,.. <br />- . v `. <br />__...... .. <br />- - <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />OFFICER /MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />E.L. DISEASE — EA AMPLOVEE <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE— POLICY LIMIT <br />OTHER <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />It is understood and agreed that the following entity is added as an additional insured but only with respect(s) to the operations of the named insured except that liability resulting from the additional insured's sole <br />negligence. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, its officers, employees, agents, representatives & volunteers <br />20 Civic Center PIE <br />Santa Ana, CA 92701- <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br />THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR <br />LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2009/01) © 1988 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />