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<br />laCyRV CERTIFICATE OF LIABILITY INSURANCE
<br />DATE MMIDDW)
<br />1/14/2014
<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 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 />PRODUCER
<br />Hayward Tilton & Rolapp Insurance Associates,
<br />CA Dept. of Ina, Lic. #0614365
<br />888 S. Disneyland Dr,, Ste 400
<br />Anaheim CA 92802 -1846
<br />N Leticia Padilla
<br />NAME "-'
<br />PI'1gNC (714)905 -19 23 Ise Na, (714) 90; 0
<br />L .letieiap @htrin a come-
<br />-ours.
<br />INSURER($)AFFDRDING COVERAGE
<br />NAIC 9P11 .
<br />INSURER A:Hartford Casualt v Insurance Co
<br />29424
<br />INSURED
<br />ID Modeling, Inc.
<br />55 E Huntington Suite 130
<br />Arcadia CA 91006
<br />INSURER B:Sentinel Insurance Com an LTD
<br />11000
<br />INSURERc:Hartford Accident & Indemnitv
<br />22357
<br />INSURER o;Underwri ter a at Lloyds of
<br />15792
<br />INSURER E:
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:14 -15 ALL & 13 -14 PL REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />WSR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY SEE.
<br />POLICY YXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$
<br />1,000 '-0.00
<br />X COMMERCIAL GENERAL LIABILITY
<br />P 1 ES FPaeoTufanm
<br />$
<br />300,090
<br />MED EXP (Any one arson
<br />$
<br />10,000
<br />A
<br />CLAIMS -MADE ®OCCUR
<br />X
<br />728BAAJ7706
<br />1/6/2014
<br />1/6/2015
<br />PERSONAL &ADV INJURY
<br />S
<br />1,000,_000
<br />GENERAL AGGREGATE
<br />$
<br />2, 000, 00
<br />GENT. AGGREGATE LIMITAPPLIES PER:
<br />PRODUCTS- COMPIOP AGO
<br />$
<br />2,000,15
<br />X POLICY 1 PRO" Lf4F,
<br />$
<br />r;T^
<br />AUTOMOBILE LIABILITY
<br />_ Mcci La IISI I'r -
<br />9
<br />1 000 OQO
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />72UECPX8358
<br />1 /6/2014
<br />:L/6/2015
<br />AUTOS NON OVJNEO
<br />:R YbAMAGE
<br />War nccklnntL
<br />$
<br />HIRED AUTOS AUTOS
<br />Uninauredmaloristccmbinod
<br />_
<br />$
<br />1,000,00
<br />X
<br />UMBRELLA ILIAD
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />2,000,000
<br />r
<br />AGGREGATE
<br />$
<br />2,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />OFD R RF.TE 71pN$ 10,000
<br />$
<br />298AAJ7706
<br />1/6/2014
<br />1/6/2015
<br />C
<br />WORKERS COMPENSATION
<br />X WC S, I OTH-
<br />B8"
<br />AND EMPLOYERS' LIABILITY
<br />-
<br />E.L. EACH ACCIDENT
<br />$
<br />1,000,000
<br />ANY PROPRIETORIPARTNERIEXECUTIVE �
<br />(Mandatory InN )EXCLUDED?
<br />(Mandatary In NH)
<br />NIA
<br />72WBCNT5100
<br />1/6/2014
<br />1/6/2015
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />1,000,000
<br />ISEASE - POLICY LIMIT
<br />$
<br />q
<br />1 000 0'�b
<br />IF yes, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />-
<br />D
<br />Professional Liability
<br />hN111071413813
<br />/30/2013
<br />3
<br />Limit
<br />3,000,000
<br />;JG
<br />DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sch o space, a redr, -�� ((��Q,
<br />-A�
<br />1F;;
<br />Certificate Holder and its agents,
<br />officers and employe ude -J A §iional Insureds
<br />and
<br />,
<br />Primary /Non - Contributory wording applies as respects Ge er tak�r,-j-,e,,} 0a 09 olicy Form SS 00
<br />08 0405
<br />attached. *CANCELLATION: 10 -days Notice
<br />for Non - Payment re i>,cayor Non - Reporting of Payroll or 30-^ -=
<br />days for all other reasons.
<br />CERTIFICATE H01 -DFR
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />The City of Santa Ana; its
<br />officers,
<br />employees,agents,volunteers
<br />and
<br />representative
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92704
<br />y�•
<br />Leticia Padilla /LOP
<br />ACORD 25 (2010/06) ©1988.2010 ACORD CORPORATION. All rights reserved':.
<br />INS025 (2oiompl The ACORD name and logo are registered marks of ACORD
<br />
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