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' - ADLER•1 _ OP ID: PRTR
<br />CERTIFICATE OF LIABILITY INSURANCE F nA;MMIDDIYYYY)
<br />nAln5Mnld
<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), AUIHORIX.ED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />__
<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 />_
<br />CONTACT
<br />NAME: T•Pa06yL PnetO
<br />Loomis Insurance Services
<br />PO
<br />PA BOX 3128
<br />PH
<br />o s.n 951885 7478 Nal_9b1 &85 0655
<br />Riverside, CA 92519
<br />, —..
<br />E-MAIL '- - -' --'
<br />ADORESS:>_IOt0o0117 iS41n6UTan0a.001'tl
<br />Michael J Runner
<br />.5220969 08/0812014 0810812016 DAMA2'E fd"RENTE77
<br />I S '100,000
<br />"INSURER(Sj, APPPRDIN4 OOVERAQE NAICA
<br />C,AIMS MADE X OCCUR ,
<br />INSURERA:Northfield Insurance Company �
<br />INSURED Adlerhorst International, Inc,
<br />�
<br />INSURER a:
<br />3951 Vernon Avenue
<br />_____..._....________ ._.._.____L._..�
<br />Rive
<br />Riverside, CA 92509
<br />INSURERD:
<br />_..... .,_..._...._._---
<br />~ X Pot ICY PRO-
<br />INSURER O
<br />AUTOMOSIL611ABILI Y I
<br />INSURER E
<br />ANY AUTO i
<br />BODILY INJURY (Per persaa) $
<br />COVERAGES CERTIFICATFNIIMRFR^ RFVI.QIf1N NIPAPIFR',
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEt.OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTI'H RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE
<br />INSURANCE AFFORDED BY THE POLICIE$ DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCE[) BY PAID CLAIMS.
<br />INSR - -�- � �ADOI TBVER --
<br />LTR' TYPE OPINSURANCE INSR WV D
<br />r POLIO EPF I POLICY
<br />POLICY NUMBER "' (droop YYYY1 I ismol YYY LIMITS
<br />1 QENERALLIAMLITY
<br />TI I EACH OCCURRENCE 5_ 1,000 ,000
<br />A X COMMERCIAL GENERAL LIABILITY X
<br />.5220969 08/0812014 0810812016 DAMA2'E fd"RENTE77
<br />I S '100,000
<br />FREMIIS4E5_(E_a, accurrencel
<br />C,AIMS MADE X OCCUR ,
<br />E NEC EXP (Any one per W 5,000
<br />PERSONAL &RDV INJURf$ 1 [)00 OQO
<br />i
<br />rGENERAL AGGREGATE g 2,000,000
<br />. gENI AGGR fgATE LIMITAYIPL PER' PE i
<br />( PRODUCTS, COMP /0P AGO : s
<br />~ X Pot ICY PRO-
<br />AUTOMOSIL611ABILI Y I
<br />("OMOINEO $INGL'LIMIT � ��
<br />ANY AUTO i
<br />BODILY INJURY (Per persaa) $
<br />ALLOWNED _SCHEDULED
<br />AUTO
<br />..�.
<br />- BO I'L� Y INJUR' Y { Per accident) 9 '
<br />j I NON -OWNED
<br />,HIRED AUTOS AUTOS '
<br />PROPERTY di1MRGE�
<br />1pER ACGIOFN'I) S
<br />.
<br />5
<br />._
<br />_.._...EACH
<br />lu MSRSLLA L1A6 DOUR
<br />EXCESS LIAE
<br />__ ..............
<br />OCCURRENCE �.S
<br />CLAWS AADE
<br />m, RETENTIONS
<br />•' 1 WORKERS COMPENSATION
<br />TI "'
<br />AGGREGATE 5
<br />_
<br />WCOIATU OTT$
<br />- _�l/
<br />AND EMPLOYERS LIABILITY YIN
<br />ANYPROPRIETORIPARTNER /E,(ECU'IVE '
<br />] pLA,1L. ��,A, CL CAC ACG DEN
<br />OF IC RINEMBER EXCLUDED? N /AI
<br />°"' °`� °4? V'�lT yrV W . �$
<br />(Mantlamryln NNI
<br />— ° —'` El DISEASE EA CMHLOYEEI s
<br />If yes dosCflbe under
<br />DESCRIPTION OF OPERATIONS below
<br />r .. -... — °- -.....
<br />Larva A' Rossini
<br />_
<br />E1 DISEASE - POLICY LIMIT $
<br />Assistant Ur ey
<br />DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (Attach ACORN 101, Atlditinnel Remarks echetlulo, If more space is requfre0)
<br />The City of Santa Ana, its officials,
<br />officers, employees, agents and
<br />volunteers are named as additional insureds.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The Cif 61 Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
<br />Y ACCORDANCE WITH THE POLICY PROVISIONS,
<br />P 0 Box 1988
<br />Santa Ana, CA 92702 4AUTxoRlzso RaP_RE NTaTIVE
<br />61988.2010 ADDED CORPORATION. All right's reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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