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- yam Policy Number. Date Entered:
<br />Ac'c�rxcF CERTIFICATE OF LIABILITY INSURANCE
<br />DAT01MMIDAVYYI
<br />TYPE OF INSURANCE
<br />1/29/2014
<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 csttifioate holder Is an ADDITIONAL INSURED, the policy(les) must be ondorsed. II SUBROGATION 1S WAIVED, subJant to
<br />the terms and conditions of the polity, certain policies may repaint an endorsement. A statement on this cortlflcate does not confer rights to the
<br />certificate holder in lieu of such andomamon s),
<br />natmmERTA-
<br />Michael Gaffra Insurance Agency
<br />496
<br />N-
<br />`-(949)494-7261------
<br />P1
<br />1949) 494-4481
<br />IN Coast BSuite A
<br />1
<br />Laguna Beach, CA 92651
<br />p opp�RssinauranceYagunaboaon@gmail. con
<br />- -.--- _._____.._
<br />INSURER(?7)APFORUINO COVERAGE
<br />_.
<br />INSUNERq: m07A INSURANCE
<br />._....�......,_�v...._...�_..._....
<br />,jNBURER a: FAki$a7ti8 INBV'RANCE dROUP
<br />.......m_.
<br />IN EUgED ORBAN FUT[TPd1@B, INC.
<br />3111 N TUSTIN
<br />SUITE 230
<br />INS RERC:__._........_,_�,_........_......_..__....
<br />ws gEreny'� _
<br />ORANGE, CA 92665
<br />MBURER E:
<br />INSU ERP:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER'
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />L
<br />TYPE OF INSURANCE
<br />lPOLICY NUMOER-
<br />1 b MM
<br />LIMiTe--�_-
<br />A
<br />GENERAL LIA6IUTY
<br />'
<br />COMMERCIAL GENERAL TLIABILITY
<br />CIAIMS-MADE its OCCUR
<br />` SMp 6351 01
<br />-
<br />2/00/2013 2/00/2014
<br />FACH OCCURRENCE
<br />p g�3fEa oav)_raneal
<br />$5,000,000
<br />,._..
<br />$100,000
<br />__..
<br />MEU Ex�one areae
<br />$?, OOO _
<br />PCRSOIJAI.&ADVINJURY
<br />$NOT COVERED
<br />-..------ -
<br />GENERAL AGGREGATE.$4
<br />, 000, O0_0
<br />GRN'L AGGREGATE
<br />HPOLICv
<br />LIMIT APPLIES PER:
<br />CRO" IAC
<br />PRODUCTBS-COMPIOPAGG ISNOT COVERED
<br />y
<br />AUTOMOBILE
<br />LWSILMEli
<br />ItleM NG 1 I
<br />4,000,000
<br />$
<br />A•
<br />ANY AUTO
<br />ALL OWNEDSCWEDOLED
<br />AUTOS AUrTOS
<br />HIRED AUTOS AUOTID3WNED
<br />..SMP 6391 01 2/00/2013
<br />DODILY INJURY (Par lmrmn)
<br />--
<br />BODILY INJURY IPgratzdanB
<br />2/00/2014 'PRTSPEflii+'BAXTA6€
<br />---
<br />$ T
<br />; "`
<br />URYRELLALIAS
<br />—µ, EXCESS LIAR
<br />OCCUpi
<br />CLAIMS•MADE
<br />EACH OGCURRCNOE
<br />AGGREGATE_.
<br />$
<br />DEC
<br />RETENTI N
<br />R
<br />-
<br />_�DEBCRIfl_„�,_
<br />WORKERSCOMPENSATION
<br />AND EMPLOYERB'LGOLLITV V/p'.ER.-.----
<br />ANY PROPRIETONIHARTNERIEXECUrIVE E0107 91 31 b2/00/2013 02/00/2074
<br />OFFIGERM1lEMEER EXCLUDEDT � RIP, E.L. EACHACCIDENT S_1rOOF,,..,.OFOF
<br />(Ma.d.tAt NN) E.L^DISEASE - EA EMPLOYEE �: $11 FOO 1000
<br />/yCa, E08GIba UM1daf
<br />7 -'ION OP OPERATIO_N_E tgNm: _ -E,L DI$EA86-P LIMIT 1$1,000,000
<br />y�
<br />M
<br />to
<br />DESCRIP'HON OF OPERATIONS I LOCATIONS IVERid LES A$aoR ACORD 101, AU4 W..I RanprXe $Phatlulo, Il mom sppaco M apdm
<br />RE CITY OF SANTA ANA, ITS 04AERS, EMPLO%EES, AGENTS, VOLtINTgo 1 IJVRq AA%q��NANED AS
<br />ADDITIONAL INSUREDS OSe & ��,Ota,
<br />Seri pLssistant City
<br />CLERK OF THE CITY COUNCIL, CITY OF BANTA ANA.
<br />20 CMC CENTER PLAZA (M-30)
<br />P.O. Box 1988
<br />SANTA ANA, CALIFORNIA 92702-1988
<br />SHOULD ANY OF THE ABOVE DBSCRIB£D POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS. -
<br />REPRESENTATIve
<br />OS FFM
<br />„v ,..+dnv name 0110 mgU RJR 11191318reO mafKS Or AGURU
<br />Pradaoed 09OU Fanta Baaa PIUa anRam, *MAC PM'm80aES.Mm', ImprexahR 0.4101111ng 30D-211&1017
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