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/l7i <br />BELLB -1 OP ID: $O <br />'4 - °tea CERTIFICATE OF LIABILITY INSURANCE <br />�+ ---^'' <br />DAr01 /2211 YYY) <br />01!22/14 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER <br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the poiiey(ies) must be endorsed. If SUBROGATION IS WANED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsament (s). <br />PRODUCER Phone: 951476.3365 <br />United Agencies, 636 {M} Fax: 951. 676 -3020 <br />CA <br />CA License #0262636 <br />27403 Ynez Rd., Sts. 110 <br />Temecula, CA 62691 <br />Ryan E. Hollander <br />CONTACT Stacy Ortiz <br />___ <br />arc "Im Ell! 951. 676.3365 _ F 951.676.3020 _ <br />lac rveT <br />naoRE; sortiz{rY,unitAdagsneies.Cam <br />IN$URER(SI AFFORDING COVERAGE <br />NAICN <br />INSURER A_Preseryer insurance Company, 1 <br />15586 <br />INSURED Ball Building Maintenance Co. <br />Mrs. Yang Charities <br />5170 Sepulveda Blvd„ #160 <br />Sherman Oaks, CA 91403 <br />INSURER B; United Specialty Ins Co <br />112537 <br />NsuRERC:TopalnsurancACOmpany <br />_ <br />16031 <br />-- <br />INSURER n 1 <br />91110/16 <br />py,Ah <br /># <br />INSURERE: <br />S 1,000,0 <br />AMAUE7578 Tr6 <br />PREMI$BS (Ea osculrencet <br />10060 <br />$ e <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 IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />N R <br />TYPE OF INSURANCE <br />OL <br />Doe <br />POLICY NUMBER <br />AWO ✓ " <br />MI POLICY V <br />LIMITS <br />B <br />BASEBALL <br />X CCMMERCIALCeli411 LIABILITY <br />CLAIMS.MAOE E OCCUR <br />X <br />X <br />U•SA4029224 <br />01110114 <br />y� <br />( }; <br />91110/16 <br />py,Ah <br /># <br />EACH OCCURRENCE <br />S 1,000,0 <br />AMAUE7578 Tr6 <br />PREMI$BS (Ea osculrencet <br />10060 <br />$ e <br />Mao E %P (Anyone el4onl <br />$ 5,09 <br />PERSONAL S ADV INJURY <br />E 11000,90 <br />{�}1J <br />"'°` <br />.� <br />GENT. AGGREGATE LIMIT APPLIES PER <br />aFNERAL AGGREGATE <br />$ 2,000,08 <br />PRODUCTS - CYMRU?AGG <br />$ 11000,00 <br />X POLICY P 0- OC <br />L <br />M�„„_.. <br />- <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AU rOS AUTOS <br />FARED AUTOS AUTO$ ED <br />i} :. <br />A6,istapt <br />Vlty / \ttorf <br />p� <br />tt <br />0 y <br />COMBINED SINGLE LIMIT <br />acct nI <br />SOCLY INJURY(PNpafar) <br />$ <br />BODILY INJURY (Per aoeldonp <br />8 �� <br />$ <br />UMBRELLA LIAR :( OCCUR <br />EACH OCCURRENCE <br />6 5,000,00 <br />AGGREGATE <br />S 61009,00 <br />C <br />X <br />EXCESSLiAB ' CLAMSMr.DE. <br />L6604662 -01 <br />01110114 <br />01110/16 <br />tl ED I X RETENTIONS <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY HROPRiETORiPARTNERf ECLHIYE i-I N; <br />OFHCERNEMSER EXCLUDED'+ 1_1 <br />{Mandalnry in NH) <br />� <br />NrA <br />WCC 0004991 <br />06102113 <br />06f02f14 <br />X TOCR II' OE H' <br />El. EACH ACCIOeNr <br />$ 1,000.90 <br />EL. DISEASE EMPLOYEE <br />$ _ 1.000,00 <br />J. DISEASE - POLICY LIMIt <br />S 7,880,00 <br />DESCRIPTION 'DE$CRWTION OP OPERATIONS bola_T <br />--f <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES lANach ACORD 191, Additional Remarks Schedule, It more apace Is nm ulmdl <br />Certificate holder, its officers, employees, agents, and representatives are <br />named as Additional Insured in rogarda to the general liability where, <br />required by written contract, with primary and non - contributory wording in <br />respects to the operations of the Name Insured, <br />CERTIFICATE HOLDER CANCELLATION <br />CITYOFS <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />Purchasing Department <br />AUTHORIZED REPRESENTAnVE <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />I <br />_/24& <br />9) 1989 -2010 ACORD CORPORATION, All rights reserved. <br />ACORD 26 {2010106) The ACORD name and logo are registered marks of ACORD <br />