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}",[[' <br />CERTIFICATE F LIABILITY IN URANCE <br />DATE(MMIDDIi`YYY} <br />Page 1 of 1 <br />0612812016 <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(ies)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 />CONTACT <br />Willis Management (Bermuda) Limited <br />NAME: -- <br />PHONE �J PAX 88 <br />Wellesley House <br />'VC No EXT 877- 945 -7378 � tAIC NCVJ 888 -46^ -2378 <br />E_MANL <br />.ADDRESS: certificates@willis.com <br />2nd. Flr., 90 Pitts Bay Rd <br />Pembroke <br />CLAIMS -MADE �C OCCUR <br />Bermuda, HM 08 <br />_____.._ INSURER(S)AFFORDINGCOVERAGE <br />NAICtt <br />INSURERA:American Unity Group Limited <br />00929 -001 <br />INSURED <br />Taller San Jose <br />INSURER B: <br />_._.... <br />INSURERC: <br />801 N. Broadway <br />Santa Ana, CA 92307 <br />S <br />�. <br />PERSONAL &ADVINJURY _- .._ <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />GEN'LAGGREGAT'ELIMIT APRIL IESRER: <br />I <br />COVERAGES CERTIFICATE NUMBER: 24507108 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 INSUIRANCE, 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 />INSR <br />TYPEOFINSURANCE ............� <br />WDLISUBF <br />- -- n <br />POLICY NUMBER <br />POLICY EFF <br />DD <br />POLICY EXP <br />M DD <br />LIMITS <br />A <br />� COMMERCIAL GENERAL LIABILITY <br />Y <br />UNICGL1601032 <br />613012016 <br />6/30%2017 <br />EACH OCCURRENCE <br />S 2,0041.., -(]00 <br />CLAIMS -MADE �C OCCUR <br />nnqq��ypq, qq pp <br />FRET WW'.ocicurenceL.__....... ....,... <br />S ................ <br />MED EX ,P (Any one person) <br />S <br />�. <br />PERSONAL &ADVINJURY _- .._ <br />_2 0.0 C1 .000 <br />GEN'LAGGREGAT'ELIMIT APRIL IESRER: <br />GENERAL AGGREGATE <br />S 2 000 00»0 <br />I PRO- <br />POLICY �. �POLICY JECT LOC <br />i <br />t <br />PRODUCTS - COMPIOPAGO <br />?.......5. 0.0.0..:000 <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />�_.. ANY AUTO <br />BODILY INJURYpPer person) <br />...,..,.._. <br />S <br />N.YSCHFDULED <br />ALLOWNED <br />AUTOS !AUTOS <br />BODILY INJLIHYIPer a c...c..__i._d.._.e..W.nt ) <br />$ <br />PROPERTYDAMAGE <br />eraccd <br />-- -_.__ ....,....__.. <br />HIREDAUTOS .NON -OWNED <br />AUTOS <br />$ <br />UMBRELLA LIAB I OCCUR <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAR C LAIMS -MADE <br />� <br />�H <br />AGGREGATE <br />$ <br />DED 'RETENTION$ <br />t <br />$ <br />WORKERS COMPENSATION <br />PER QTH <br />mm__ ,,TAT TE ER <br />._ <br />AND EMPLOYERS' LIABILITY <br />ANY PRO PRIETORIPARTNERVEXECUTVVEY� <br />NIA <br />'�. EL EACH ACCIDENT <br />DER FR/MEMBER EXCLUDED? <br />.__. ._..,,.__ .__.._._..__ _.,_..._....._ <br />fMandlatory in NR) <br />E.L. DISEASE - EA EMPLOYEE <br />$.. <br />ft yes, describe under <br />DESCRPTIONOFOPERATONSbelcw <br />F.LDISEASE- POLICYLIM.IT $ <br />DESCRIPTION OF' OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additona�i Remarks Schedule, maybe attached if more space is required) <br />The Certificate Holder is named as Additional insured by endorsement to the policy subject to the <br />terms sfJose, in <br />Taller San Block Grants - 810 N. Poinsetta, Santa Ana, CA 92701 � r�... I—Q k3. ,a d�' <br />w , � <br />MEN= <br />Coll:4921779 Tpl:2068071 Cert:24�'07108 @ 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <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 />Santa Ana Work: Center <br />AUTHORIZED REPRESENTATIVE <br />1000 E. Santa Ana, Blvd. <br />Suite 2000 <br />Santa Ana, CA 92701 <br />Coll:4921779 Tpl:2068071 Cert:24�'07108 @ 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />