KARMINA RESTAURANT - 2012 - Laserfiche WebLink

Home Browse Search

Ac�o/za® CERTIFICATE OF LIABILITY INSURANCE Doaizoi2o 3""' 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 endorsemenl(s), PRODUCER Sariah Devereaux, Agent CONTACT NAME: Sanah Devereaux 1202 IN1st St Statearm Santa Ana, CA 92703 FAX PNONE 14- 4 d 80 IAIC. Noll 4-38 3892 statefarm.com ADDRESS: sadah.devereaux.t8lb@statefarm.com INSURERS AFFORDING COVE RAGE NAM INSURER A: State Farm General l nsurance Company 25151 v INSURED Carlos Madriles INSURER B: INSURER C: DBA Downtown Stadium Grill INSURERD: 602 N Flower St, Santa Ana, CA 92703 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, ILTN TYPE OF INSURANCE AOOL UBR POLICY NUMBER MMIDCY� PMIDC YEYXYPI' LIMITS A GENERAL LIABILITY FI ❑ 92CSG2465 0812012013 08/20/2014 EACH OCCURRENCE $ 1.000,000 DAMAGE 10 RENTED PREMISES Ea occurrence $ 300,000 x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR MED EXP (My oneperson) $ 6,000 PERSONAL &ADV INJURY $ 11000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP,0PAGG $ 2,000,000 Business Property $ 25,000 POLICY L PRO LOC AUTOMOBILE LIABILITY ❑❑ E accl0eltB 0LE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AO SWNED BODILY I NJURY(Per accldet) $ PROPERTY accidenDAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ E%CE$S LIAR CLAIMS -MADE DEO RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPMETORIPARTNEWEXECUTIVE YIN OFFICENEMBER EXCLUDEDI 1:1NIA (Mandatory in NH) El WC TA7UOTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EX DISEASE - POLICY LIMIT $ If yes, describe under OESCRIP nON OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, B more apace is required) Certificate holder, it's officers, agents, and employees are named as Additional Insured In regards to General Liability. .As T jX1Di'R®VF-D - *30 days notice of cancellation for nonpayment. 1.19A F ,, STOFtC4C tani Ci y AtiorneY Additional Insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana, its officers, employees, agents, and ACCORDANCE WITH THE POLICY PROVISIONS. representatives-Attn: Purchasing Dept AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza; Santa Ana, CA 92701 © 1 68.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered mar s Df ACORD 1001486 132849.8 01-23-2013