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Client#:62862
<br />14BAYAREADRI
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<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />DAT0IVYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />10//31/231/2013
<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 policypes) 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
<br />CONT A T
<br />NAME:
<br />J. Smith Lanier & Co. -Atlanta
<br />PHONE 770 476-1770 FAX 770 476.3651
<br />AIC, No, Ext: AIC, No
<br />11330 Lakefield DriveEMAIL
<br />'p
<br />Bldg 1, Suite 100 Iv i�13 r 13
<br />ADDRESS;
<br />INSURER(S) OVERAGE
<br />NAIC#
<br />Duluth, GA 30097
<br />demnity In
<br />INSURER A: Philadelphia Indemnity Insuranc
<br />18058
<br />INSURED
<br />Henry Ramirez dba Bay Area Driving;
<br />INSURER B,
<br />PREMISE Ee occurance $100,000
<br />Driving School Safety Drivers Ed LLC
<br />INSURER C:
<br />1070 A. Street
<br />INSURER D :
<br />Hayward, CA 94541
<br />INSURER E:
<br />INSURER F:
<br />GEHL AGGREGATE LIMIT APPLIES PER:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 CONTRACTOR 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 THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF RANCE
<br />ADOLSUBR
<br />INSR
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMM IYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />PHPK1095272
<br />11/01/2013
<br />11101/2014
<br />EACHOCCURRENCE $1 000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />PREMISE Ee occurance $100,000
<br />MED EXP (Any one parson) $5,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GENERAL AGGREGATE $2,000,000
<br />GEHL AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />X POLICY JECOT LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK1095272
<br />11/01/2013
<br />11/01/201
<br />COMBINEDSI NO LE LIMIT
<br />Ea accident $500,000
<br />BODILY INJURY(Par Person) $
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOSALTOS
<br />:r�^
<br />BODILY INJURY (Per accldenQ $
<br />X
<br />HIRED X AOT-OAUTOSWNED
<br />' r,
<br />rt �„y 4*{`,,
<br />5 A
<br />1;L F��
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />a�T�{�
<br />1�
<br />N~"�-
<br />EACH OCCURRENCE $
<br />EXCESS LIAB
<br />CLAIMS-MADECy(
<br />AGGREGATE $
<br />��.r-- E•
<br />7 rn(,y1
<br />DED RETENTION$
<br />$
<br />WORKERS COMPNSATION12�
<br />ELABILIITV YIN
<br />AND EMPLO ERSANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />psslstant
<br />TO STATU- OTH-
<br />GIBY
<br />PAL. EACH ACCIDENT $
<br />EL. DISEASE -EA EMPLOYEE $
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY IT $
<br />A
<br />Property Building
<br />PHPK1095272
<br />11/01/2013
<br />11/01/201
<br />357,000
<br />Bus. Pers. Prop.
<br />30,000
<br />DeductibleFFI1,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />The City of Santa Ana, its officers, employees, agents, representatives and volunteers are included as
<br />Additional Insured as respects General Liability Coverage, but only for work performed by or on behalf of
<br />the Named Insured
<br />Loc# 1 - 1070 A. Street; Hayward, CA
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />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 />n 19111R.4010 ACORn CnRPQRATInN All nlnhfa .-rod
<br />ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S2071871/M2071856 LZA
<br />
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