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DATE (MWDDNYYY) <br />A� CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 06/27/2012 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES ER IF CATE OF AFFIRMATIVELY SURANCE DOES NEGATIVELY <br />CONSTITUTE A CONTRACT COVERAGE AFFORDED BY <br />INSURER(S)TAUTHOR AUTHORIZED BELOW. THIS CERTIFICATE <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />Willis Management (Bermuda) Limited <br />58 Par -la -Ville Road <br />P. O. Box 1995 <br />Hamilton <br />Bermuda, HM HX <br />Taller San Jose <br />801 N. Broadway <br />Santa Ana, CA 92307 <br />=HONE 945 7378 a/`c Not <br />877 <br />888- 467 -2378 <br />A!C NO EXT) <br />= -MAIL <br />certificates@willis.cOm <br />PRO• LOC <br />g POLICY E T <br />RES <br />ADDS: <br />NAIC # <br />INSURER(S)AFFORDING COVERAGE <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ <br />BODILY INJURY(Per person) $ <br />AUTOMOBILE LIABILITY <br />Unity Group Limited <br />C0929 -001 <br />INSURERA:American <br />ANY AUTO <br />INSURER B <br />INSURER C <br />INSURER D <br />INSURER E <br />-2012--12-7— INSURERF: <br />REVISION NUMBER: <br />COVERAGES CERTIFICATE NUMBER: 18110856 E BEEN ISSUED T <br />INDICATED. NOTWITHSTANDING ANY IREOUIREMENTNTERM OR CONDITION OF ANY CONTRACTOOR THE INSURED NAMED OTHER R DOCUMENT WIOTHERESPECT TO ICH THIS <br />THIS IS TO CERTIFY THAT THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT t-0 ALC HE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN PREDUCED BY PAID OCLAIMS. <br />LIMITS <br />NSR DD' SUB POLICYNUMBER M D YY MWDD YY <br />LTR TYPEOFINSURANCE NSR EACHOCCURRENCE $ 2 000 00 <br />A GENERAL LIABILITY Y UNICGL1201028 6/30/2012 6/30/2013 DAMAGE TO RENTED <br />PREMISES Eaoccurence $ <br />X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ <br />CLAIMS -MADE OCCUR <br />PERSONAL& ADV INJURY $ 2 000 00 <br />GENERAL AGGREGATE $ 2 000 00 <br />PRODUCTS - COMP/OP AGG $ 5,000,00 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />$ <br />PRO• LOC <br />g POLICY E T <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ <br />BODILY INJURY(Per person) $ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />BODILY INJURY(Per accident) <br />ALLOWNED SCHEDULED <br />TOS <br />PROPERTYDAMAGE <br />$ <br />AUTOS NON -OWNED <br />Per accident <br />HIREDAUTOS AUTOS <br />$ <br />EACHOCCURRENCE $ <br />UMBRELLA LIAB OCCUR <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE $ <br />DED RETENTION $ <br />- <br />r`` <br />WC STATU- TH- <br />TORY LIMITS ER <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVEY❑ <br />N/A <br />_ <br />C <br />r- <br />p- <br />Y` <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />OFFICER/MEMBER EXCLUDED? <br />`Op <br />1� <br />P I' <br />rney <br />(Mandatory ,inNH) <br />ft describe under <br />L� <br />PAC <br />E. L. DISEASE - POLICY LIMIT $ <br />yes, <br />DESCRIPTION OF OPERATIONS below <br />w rct_ <br />DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required) <br />The Certificate Holder is named as Additional Insured by endorsement to the policy subject to the <br />terms set forth in the endorsement. <br />Taller San Jose, Block Grant - 810 N. Poinsetta, Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana Work Center <br />1000 S. Santa Ana Blvd. <br />Suite 2000 <br />Santa Ana, CA 92701 <br />Coll:3776604 Tpl:1469392 C 1085 © 1988- 2010ACORD CORPORATION. All rigntsresem <br />- - -- - -- -- + r--^ ­= rpnistered marks of ACORD <br />