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Policy Number. STE10091/STF20091 Date Entered: 03/27/2011 AcoftcO® CERTIFICATE OF LIABILITY INSURANCE 6 DATE IMMIDD[YYYY) .? 3/27/2013 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 endorsement(s). PRODUCER COT C EBAMARTNT NAME: MCIS AIC.N . (310) 390-0777 AIC NO: (310) 390-0222 PHONE 13900 TAHITI WAY #327 E-MAIL LOLITA@MANATEKINS.COM ADDRESS: MARINA DEL REY 90292 INSURERS AFFORDING COVERAGE NAIC# INSURER A: STATE NATIONAL INSURANCE COMPANY 12831 INSURED BEN WARNER'S GARAGE, INC. INSURER B: INSURER C 818 E. WALNUT AVENUE INSURER D: SANTA ANA, CA 92701 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 ADDIL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE R I D POLICYNUMBER MMIDDII'YYY MMIDDIYYYV LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1 000 000 DAMAGE RENTED A COMMERCIAL GENERAL LIABILITY X PREMISES (Eeoccurrence) $100,000 CLAIMS-MAOE Ix OCCUR STF20091 6/13/2012 6/13/2013 MED EXPAny one person) $5,000 GARAGE LIAB. PERSONAL B ADV INJURY $1 000 000 GENERAL AGGREGATE $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2 000 000 POLICY PRO- LOC SECT $ AUT OMOBILE LIABILITY C OMBINED SINGLE LIMIT (Ed accident) $ 11000,000 ANY AUTO x BODILY I NJ URV(Per person) $ ALL OWNED Fq?A SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS A AUTOS HIRED NO-OWNED STE 10091 6/13/2012 6/13/2013 Per PROPEPERTident) DAMAGE $ UMBRELLALIAB OCCUR Rhin" V EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE ` ? AGGREGATE $ ?VtJ ? - DED RETENTION $ $ WORKERS COMPENSATION ura L OSSIIl WC STATU- O H- AND EMPLOYERS' LIABILITY a E YIN k ' ANY PROPRIETORIPARTNERIEXECUTIVE NIA p y CR S5ISyy 6aII? ? OI t6II Y E.L. EACH ACCIDENT § ? OFFICERIMEMBER EXCLUDED? E . (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, descrlbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ A ON-HOOK/CARGO STE10091 6/13/2012 6/13/2013 $100,000 $1,000 DIED. A PHYSICAL DAMAGE ? i STE10091 ? 6/13/2012 6/13/2013 COMP. & COLL. $1,000 DED. A GKDP STE10091 6/13/2012 6/13/2013 $100,000 $1,000 DED. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY WITH RESPECTS TO LIABILITY ARISING FROM THE OPERATIONS OF THE NAMED INSURED. ****30 DAY CANCELLATION CLAUSE.**** **SPECIAL ENDORSEMENT** CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ITS OFFICER, EMPLOYEES, AGENTS AND VOLUNTEERS ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: PURCHASING DEPT 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE /°? SANTA ANA, CA 92701-9010 LOLITA BAHRAINI ACORD 25 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Producedusing Forms Boss Plus software.www.FormsBoss.comlmpressivePublishing 800-208-1977