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THIS CANCELS AND REPS CERTIFICATE ISSUED 10/10/11 (ADD DESCRIP iW0 ADDITIONAL INSURED ENDORSEMENT) ACOIRD® CERTIFICATE OF LIABILITY INSURANCE D11/9/2011' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT Alli i NAME: ant Insurance Serv ces, Inc. PHONE: PHONE: 1301 Dove St., Suite 200 A/C. NO, Newport Beach, CA 92660 E-MAILADDRESS: 949-756-0271• Fax 949-756-2713• License No. OC36861 PRODUCER: ....CUSTOMER ID # INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: --.................. INSURER(S) AFFORDING COVERAGE NAIC # PAINT YOUR HEART OUT, INC. 1260 N HANCOCK UNIT 103 INSURERA: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 . , ANAHEIM, CA 92807 INSURER B: INSURER C: ,,,,_„_..-__ ....................... -...__._..._.._--...... -...----------- -.--------- INSURER D: INSURER E: ....................................................................................................................................................................................................................................... .................................................. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EF (MM/DDIYY) POLICY (MM/DD/YY) LIMITS A GENERAL LIABILITY X PAC 1000001 00 09/29/11 09/29/12 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea Occurrence $1,000'000 CLAIMS MADE 5E OCCUR MED EXPR (Any one person) N/A GLDED: $1,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE NA' POLICY PRO- LOC PRODUCTS-COMP/OPAGG. $1,000,000 A AUT OMOBILE LIABILITY PAC 1000001 00 09/29/11 09/29/12 COMBINED SINGLE LIMIT Ea Accident $1,000,000 ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS t? BODILY INJURY (Per accident) SCHEDULED AUTOS ?? r PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED AUTOS ' S o^ K AUTO DED: $1 000 1 G PV Z O , 1 S UMBRELLA LIAB OCCUR illid Ctt7 EACH OCCURRENCE CLAIMS ta ArjSts EXCESS LIAB t AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY TORY LIMITS ER ANV PROPRIETORY/PARTNER/EXECUTIVE ? N/A OFFICER/ MEMBER EXCLUDED? E.L. EACH ACCIDENT (MANDATORY IN NH) IF YES, DESCRIBE E.L. DISEASE - EA EMPLOYEE UNDER DESCRIPTION OF OPERATIONS BELOW -___-_.__ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES )Attach Acord 101, Additional Remarks Schedules, i(mors space is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS TO THE AGREEMENT WITH THE CITY OF SANTA ANA. THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND NOT AFFECTED BY ANY OTHER INSURANCE CARRIED BY SUCH ADDITIONAL INSURED WHETHER PRIMARY EXCESS CONTINGENT OR ON ANY OTHER BASIS , , , . SEVERABILITY OF INTERESTS: THE TERMS "PARTICIPATING NAMED INSURED" AND "INSURED" ARE USED SEVERALLY AND NOT COLLECTIVELY, BUT THE INCLUSION HEREIN OF MORE THAN ONE "PARTICIPATING NAMED INSURED" OR "INSURED" SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE "COMPANY'S" LIABILITY. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: FRANK HERNANDEZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MANAGEMENT AIDE ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 62008 ACORD CORPORATION. All rights reserved.