SANO, CHIHIRO 1C - 2015 - Laserfiche WebLink

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DATE qMM/DD/YYYY) �,► � � CERTIFICATE OF LIABILITY INSURANCE J1/p9/2015 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFOR'MATIO'N MrRti.ore Insuuan eAgency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 27104 Puerta Real Suite 260 HOLDER. THIS CERTIFICATE DOES NOT AMMEND,EXTEND OR 877.43n'7459 CA92691ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 877.A38.7489 INSURERS AFFORDING COVERAGE NAIC # INSURED�„ INSURER A: Philad Iph a Ilmd ry 1 u Company 18659 Chihiro Sano I ._ pq .._...., 106 Yorktown Ln ".r'' N i g ,, "^ 4�'" C. )� L n INSURER B: INSURER C: ..__..._._...._ ............._,._.....,..._..�. Costa Muria, CA 92626- INSURER D: INSURER E.--.. COVERAGES THE POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. _..m...._ .....______._._._...._.._.. _ INSR ADO"L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE.(MM/DD/YYYY) DATE (MM/DO/YYYY) LIMITS -A x GENERAL LIABILITY PHPK803569-004 12./08/2015 12/98)2046 EACH OCCURENCE $1,990,000 DA A E TO RENTED PREMISES Ea ocbw rence $:100,080 X COMMERCBAt. GENERAL LIABILITY CL.AII.MS MADE OCCUR MED EXP Any one personM $2,590 X PROFESSIONAL LIABILITY PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $310001000 PRODUCTS - COMP/OP AGG $3,000,009 IS ACi I EGA'IE LIMIT APPLIES PER: x , POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE UMLT ANY AUTO (EA accident) BODILY INPURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY ._._...m..., HIRED AUTOS NON OWNED AUTOS I'Peraccidentl PROPERTY DAMAGE (Per accident) GARAGE: LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHF.R THAN EA ACC AUTO ONLY : ,,....._..... .......... ... .... ..__.._. o AGG EXCESS / UMBRELLA LIABILITY . A EACH OCCU'RENC£ OCCUR E] CLAIMS MADE r AGGREGATEM "_.,' RETENTJUN WORKERS EMPLOYERS' LIABILITY Y N \ C 'GORY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDE �y"�,r✓ '�+" k E L. EACH ACCIDENT (Mandatory In NHI \ ,. E.L. DISEASE - AEA AMPLOYEE Yes,A( @ under C.E. DESEASE - POLICY OMIT PR' SPECIAL PROVISIONS the law OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS It is understood and agreed that the Lbllowing entity is addad as an add ti—f insured but only with respect(s) to the operations of the named imured except that habiility resulting from the additional insured's sale neighgence.. CERTIFICATE HOLDER CANCELLATION City of Santa Ana, its officers, employees, agents, representatives & volunteers 20 Civic Center Piz Santa Ana, CA 92701 - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE'. CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPR€SENTATIVES.. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) Q 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and, logo are registered marks of ACORD