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A4 <br />PRODUCER <br />Maguire Insurance Agency, Iroc,. <br />23101. Puerta Reay Suite 2.04 <br />Mlssion'Uiejo, CA 926911- <br />877.4 38.7459 <br />INSURED <br />Chihlro Sarno <br />1016 Yorktown Ln <br />Costa Mesa, CA 92626 - <br />COVERAGES <br />DATE (MM/DD/YYYY) <br />11/09/2615 <br />THIS CERTIFICATION 15 ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERB: <br />INSURER C: <br />INSURER D: <br />NAIC <br />18058 <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIF'ICATIONI MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM'S. <br />INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION <br />LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYYY) DATE (MM/DD/YYYY) LIMITS <br />A <br />X <br />GENERAL LIABILITY <br />PI°IPK803569-004 <br />12/08/2015 <br />12108/2016 <br />EACH CICCURENCE $1,000,000 <br />..,.�DAMAGE <br />COMMERCIALGENERAL LIABILITY <br />TO <br />PREMIISFSCRpN RENTED ncs I'I $1,00,000 <br />CLAIMS MADE OCCUR <br />MED EXP (Any once person) 52,$00 <br />PERSONAL&ADV INJURY $1,900,004 <br />X PROFE.SSIONALIIABIILITY <br />....GENERAL AGGREGATE $3,000,000 <br />G EN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OPAGG $3,000,�P00 <br />X POLICY PROJECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />IEA accident) <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY <br />FARED AUTOS <br />......_, <br />NONOWNEDAUTOS <br />(PeT accident) <br />PROPERTY DAMAGE'. <br />I <br />(Per accident) <br />GARAGE <br />LIABILITY <br />AUTO ONLY- EA ACCIDENT' <br />OTHER THAN EA ACC <br />ANY AUTO <br />AUTO ONLY: AGG <br />EXCESS <br />/ UMBRELLA LIABILITY <br />EACH OCCURENCE <br />OCCUR 1:1 CLAIMS MADE <br />AGGREGATE <br />DEUUCTII3LI <br />RETENTION <br />WORKERS COMPENSATION AND <br />77-7-77-TM'O H <br />EMPLOYERS' LIABILITY Y� <br />FORV LIMITS ER <br />EL, EACH ACCIDENT <br />- ._. .w. _.__....... <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMRER EXCLU <br />(Mandatory in NEN) <br />E.L. DISEASE - EA AMPLOYEE <br />Eyes, describe under <br />PECIAI. PROVISIONS below <br />-,..-.. .............. _.._,_._._._._....... .....___......_ <br />E.L. DISEASE POLICY LIMIT <br />OTHER <br />a C, <br />A <br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES { EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 4 <br />It is ndersteod and ae,reed that the following entity is added as an additional insured but only with respects) to the operations of the panned insure�dye,�,c; at habit' rs ulting f the, additional insureds sale <br />nraghllnnce Px, <br />LtK I III I t MULI LA144-1:1 I IUIIV ,,xis" — 1j4 .g <br />City of $ant. Ana Parks, Recreation and Community Services Agency AHn Silvia Cuevas <br />26 Civac Cenler Plaza <br />Santa Ana., CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLS'BE CANCELLED BEFORE THE EXPIRATION DATE <br />THEREOF,, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR. <br />LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENT$ OR REPRESENTATIVES.. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2009/01) D 1088-2009 ACORD CORPORATION. All rights reserved, <br />The ACORD name and logo are registered marks of ACORD <br />