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ACOR[?� CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDOIYYYY) <br />11/04/2015 <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 />CONTACT <br />NAME: <br />Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA <br />ANCNE (888) 202-3007 ID No <br />520 Madison Avenue <br />ADDRESS: contact@hiscox.com <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />32nd Floor <br />INSURER A: Hiscox Insurance Company Inc 10200 <br />New York, NY 10022 <br />INSURED <br />INSURER B, <br />INSURER C: <br />Luis Martinez <br />INSURER D: <br />62 Civic Center Plaza <br />INSURER E: <br />PO Box 1981 <br />Santa Ana N,a2)1A-142. CA 92703 <br />INSURER F: <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 />INSR <br />LTR <br />rypE OF <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDAfYYY <br />POLICY EXP <br />MMIDDIYYVY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />UDC -1654609 -CGL -15 <br />11/04/2015 <br />11/04/2016 <br />EACH OCCURRENCE $ 1,000,000 <br />DAMAGE IU RENTED <br />PREMISES Ee occurrence $ 100,000 <br />MED EXP (Any one person) S 5,000 <br />PERSONALxADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY [:�] JECT [:] LOC <br />OTHER' <br />GENERALAGGREGATE $ 2,000,000 <br />PRODUCTS - COMPIOP AGG s SIT Gen. Agg. <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />COMBINED SINGLE LIMIT $ <br />Ea accident) <br />BODILY INJURY (Par person) $ <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Par accident <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DEO RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRIETORIPARTNERIEXECUTIVE ❑ <br />OFFICERIM EMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE -POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AdditionalRemarks Schedule, maybe attached if more space is requiretl) <br />CERTIFICATE HOLDER CANCELLATION <br />(D1988.2014 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 />AUTHORIZED REPRESENTATIVE <br />(D1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />