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CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY)
<br />�. 7'i23/2C 2
<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 BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<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 />PRODUCER tllt< „?�:: (?10)47 ,,U <;; CONTACT
<br />)a_\ 1., ?4 7 i. NAME: __. ---..
<br />r ..... - - -. _ .-
<br />T.__.
<br />. PHONE i FAX
<br />Vi S <i.l..l�, K �aS� ...:�.le ; ___.._ (An. No). ..-- -.
<br />jAlC No ExtJ: __ _...._.
<br />E -MAIL —
<br />_ ADDRESS: __
<br />5 J/
<br />INSURER(S) AFFORDING COVERAGE NAIC N
<br />.. -._._ __.. _..._ ._...._ . - -- ---- - --- -- INSURER A / 1 '. t t ::. i it <.t,:. �,..i.,h.i : ' 165 .15
<br />INSURED ._._. -.... _ ....
<br />INSURER B
<br />,i1.1 j; ,. �� INSURERC:
<br />C ii3 c , ,,i? ,iiiiz<.iitcC,,lt ILialS.i7tj ,ii51: I'll, 2U24 _ 7
<br />3, % 2 ? � ,, , iL - 7__ 6INSURERD 77
<br />nJ INSURER E:
<br />COVFRAGFS CFRTIFICATF MIIUA1=0- :i'I'i':n CCa_i ncvr��nwr ur�aanr_rs
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE ISUBQ(:E' ..t_ (-POLICY EFFl E POLICY EXP
<br />LTR POLICY NUMBER ! MMtDDfYYYY MMIDD!
<br />—�
<br />LIMITS
<br />'. GENERAL LIABILITY
<br />k--
<br />'t zt [hF:)1 00 .yam
<br />- ,...
<br />�i`< 2{'312
<br />EACH OCCURRENCE
<br />$
<br />n
<br />Ii�l
<br />COMMERCIAL GENERAL LIABILITY
<br />s +
<br />!
<br />DAMA(,E T� RANTED
<br />PREMISES (En occurrence)
<br />$
<br />j !�
<br />f U [
<br />r
<br />i CLAIMS MADE I dr , OCCUR I
<br />MED EXP (Any one person)
<br />$
<br />i C,000
<br />__. ....
<br />PERSONAL & ADV INJURY
<br />_....._...
<br />$
<br />C.OU
<br />.. — ..._. _..._. ..
<br />i
<br />I
<br />GENERAL AGGREGATE
<br />$
<br />CE!
<br />PLIES N'L AGGREGATE LIMIT APPLIES PER:
<br />i
<br />PRODUCTS - COMPlOP AGG
<br />. -.. -..
<br />PRO-
<br />POLICY T LOC
<br />i $
<br />.._.___.
<br />AUTOMOBILE LIABILITY j
<br />a +r_li'K 8:, I� >l3, ,
<br />C ,.J(} , .,
<br />(}
<br />COMBINED SINGLE LIMIT
<br />j
<br />'
<br />1 ANY AUTO _
<br />ALL
<br />(Ea accuientL__
<br />DILY INJURY (Per person)
<br />$
<br />OWNED .. SCHEDULED J
<br />AUTOS AUTOS i
<br />r BODILY INJURY (Per accident)
<br />! $
<br />1� NON - OWNED !
<br />✓ HIRED AUTOS y i AUTOS %
<br />€
<br />I
<br />PROPERTY DAMAGE
<br />$
<br />!
<br />Per accident)
<br />$
<br />yy
<br />- -_
<br />UMBRELLA LIAB , .. '
<br />_ OCCUR I
<br />f .> h 7 N. OC` -/1:2012
<br />'' ' '�
<br />'v
<br />EACH OCCURRENCE
<br />_-
<br />$
<br />€ 1 f n
<br />€ .fj(t '} ,7
<br />EXCESS UAB CLAIMSMADE!
<br />[
<br />AGGREGATE
<br />-�
<br />$
<br />-
<br />° t7 JC}i 00,
<br />DED ' ✓ - RE TEN TION$ € I
<br />I
<br />1 WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY ,
<br />j
<br />,,, ''l', -2012
<br />IZC.-_ ° z,z ? -+
<br />t., 't
<br />S 't0
<br />;
<br />✓ 2 S�ATU OTH-
<br />RY IMITS
<br />Y f N
<br />ANY PROPRI ETOR/PARI'NER/EXECUTIVE ”" I
<br />�T i
<br />-
<br />000,0010
<br />OFFICERIMEMBER EXCLUDED? i N ! At
<br />E L
<br />._. _ EACH ACCIDENT --
<br />$ ._
<br />1,000,0010
<br />(Mandatary in NH)
<br />If yes, describe under
<br />DESCRIPTION
<br />i
<br />E.L. DISEASE -EA EMPLOYEE
<br />OF OPERATIONS below ) !
<br />i
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />1,000,000
<br />i I
<br />I4l1.`2012
<br />t:t ii 1
<br />3.1.,0 0
<br />DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
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<br />� _ ri .. f J t -. '7 ..
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<br />.._ 3 � t, or, .� C
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<br />:C t Z7 P.
<br />Idl y poli,cY, k�Y ['1 al,C N G..i .:: F`_,- ,::(..�y ccve.rage C.l au w-'!- SL
<br />apply. �
<br />rr exal '_,ia i y :,,. i .e: os Cancc ^?3.a;._:,:, ve_,._li _ Gb.:.
<br />ti.. 30 C 1. ✓^ fc.
<br />'.J.
<br />1
<br />--- . - -- --- -...._ 1.----.,- i /_LI---- GANULLLA I ION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />.rC'La O ;F Se_.'. 2: Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />2 {I C`ivit: {_;et.,er `,'laza
<br />�art1 Ana, CA 9270.1 AUTHORIZED REPRESENTATIVE
<br />OVA
<br />©1988 -2010 ACORD CORPORATION. All riht reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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