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From'. Cynthia Brown FaXID: Page 2 of 2 Dale:4/3/2014 12'.09 PM Page:2 of 2 <br />TORRE-2 OP ID: CB <br />4c_�o�zo° CERTIFICATE OF LIABILITY INSURANCE <br />DATE 103/2 Y4 <br />0410312014 <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 policy(les) 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 />PRODUCERN <br />Insurance Incorporated <br />6809 Indiana Ave#202 <br />NAME <br />PHONE FA% <br />JAIC. No Ext AIC, No <br />EMAIL <br />ADDRESS: <br />Riverside, CA 92506 <br />Timothy E Dean <br />INSURER(S) AFFORDING COVERAGE NAIC A <br />INSURERA', State Comp Insurance Fund 35076 <br />EACH OCCURRENCE $ <br />INSURED Torres Maintenance <br />DBA: TMC Shooting Range <br />Specialist <br />27431 Santa Clarita Rd <br />INSURER B'. <br />INSURER C'. <br />INSURER D: <br />INSURERE: <br />Santa Clarita, CA 91350 <br />INSURERF' <br />$ <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFYTHAT 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 IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />POLICY NUMBER <br />FOLIC YYYY Y EFF <br />EXP <br />POLICYYYYY <br />LIMITS <br />AUTHORIZED REPRESENTATIVE <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE 11 OCCUR <br />APPROVED ASR <br />V.II'�1J t19 <br />1 <br />EACH OCCURRENCE $ <br />7TA9TGE TO RENTED <br />PREMISES(Ea occurrence $ <br />MED POP(Any one person) $ <br />PERSONAL & ADV INJURY I <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LINIIT APPLIES PER. <br />1 POLICY P" TF -1 LOC <br />PRODUCTS-COMPIOPAGG $ <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />'�"`"' "T;""'- <br />��Y,�`aura♦. <br />CO isED SINGLE LIMIT <br />Ea eccldenr $ <br />BODILY INJURY (Per parson) 16 <br />ryr�^ <br />A. Rossini <br />q 4 a <br />Assistatnt City <br />tto'rney <br />BODILY INJURY (For ecciden) �$ <br />PROPERTY DAMAGE $ <br />PER ACCIDENT <br />$ <br />UMBRELLA LIAROCCUR <br />EXCESS LIAR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED RETENTION$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYTORY <br />ANY PROPRIETORIPARTNER/EXECUTIVE YIN <br />OFFICERIMEMBER EXCLUCE07 <br />(Mandatory in NH) <br />If,e, describe undo, <br />DESCRIPTION OF OPERATIONS LdINY <br />NIA <br />907014513 <br />08/24/2013 <br />08/24/2014 <br />X WCSTATU- OTH- <br />IN TO ER <br />E . EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE-EAENIPLOYEE $ 1,000,000 <br />E . DISEASE, POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rinruk. Schedule, if more space is required) <br />*Ten-day notice of cancellation provided in the event of cancellation due to <br />nonpayment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />STNAPOL <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Garrison Fradella <br />P.O. Box 1981, M97 <br />Santa Ana, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />RECEIVE: NO.1622 04/03/2014/THU 10:57AM <br />