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,AcoRb;v <br />PRODUCER <br />Magu Ire Insurance Agency, Inc <br />27101 Puerta Real Suite 200 <br />Mlsslon Vlaq CA92691- <br />8)].438.2459 <br />INSURED <br />Chihiro Sano <br />106 Yorktown Ln <br />Costa Mesa, CA 92626 <br />COVERAGES <br />CERTIFICATE OF LIABILITY INSURANCE <br />THIS CERTIFICATION IS 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 />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 CERIFICATION 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 CLAIMS. <br />IN5R <br />ADO'L <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />LTR <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE(MM/DD/YYYY) <br />DATE(MM/DD/YYYYI <br />LIMITS <br />A <br />X <br />GENERAL LIABILITY <br />PHPK803569-003 <br />12/08/2014 <br />12/08/2015 <br />EACH OCCURENCE $1,090,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE IT OCCUR <br />RENTED <br />PREMISES AMAGE �a occurrence $100,000 <br />MED EXP (Anyone person) $2,500 <br />PERSONAL&ADV INJURY $1,000,000 <br />X PROFESSIONAL LIABILITY <br />GENERAL AGGREGATE $3,000,900 <br />PRODUCTS—COMP/OPAGG $3,000,000 <br />GEWL A60REGATEERyl PHf$PER: <br />% POLICY PROTECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />ANYAUTO <br />(EAaccldent) <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Perperean) <br />BODILYINJURY <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />(PeraceXcl) <br />PROPERTY DAMAGE <br />(Peraccldent) <br />GARAGE LIABILITY <br />AUTO ONLY— EA ACCIDENT <br />OTHER TITAN EA ACC <br />ANYAUTO <br />AUTO ONLY: AGO <br />EXCESS / UMBRELLA LIABILITY <br />EACH OCCURENCE <br />AGGREGATE <br />OCCUR E] CIAIMSMADE <br />DEDUCTIBLE <br />'\V(�V <br />RETENTION <br />V� <br />WORKER PE <br />EMPLOYERS'LIABIL//ITY VN <br />WCSTAT OTH- <br />TORY LIMITS ER <br />// <br />L. EACH ACCIDENT <br />OFFICER/MEMBER <br />OFFICER%MEMB <br />EL. DISEASE -6A AMPLOYEE <br />(Mandatory inNHR <br />(pA`Ia5 <br />under <br />SPECIAL PROVISIONS Stic <br />s�``a <br />�Y` <br />E.L. DISEASE—POLICY LIMIT <br />OTHER <br />all <br />45 <br />VV C <br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />Itis understood and agreed that the following entity is added as an addiCona l insured but only with respect(,) to the operations of the named Insured except that UdRlty r.aWting from the additlona l Insured', sole <br />negligence. <br />CERTIFICATE HOLDER CANCELLATION <br />Cltyof Santa Ana Parks, Recreation and Community Services Agency Attn: Silvia Cuevas <br />26 CIVIC Center Plaza <br />Santa Ana, CA 92781- <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />`/YI (/D <br />ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved, <br />The ACORD name and logo are registered marks of ACORD <br />