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Client#: 1259431 305CORDOCOR ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NCNTAMEACT Christy Mata BB&T Insurance Services PHONE F 877-297-9247 (A/C, No, ExtL714 941-2870 AAX /C,-N�----—_...._... of Orange County E-MAILS: CMata@bbandt.com Katella Avenue Ste 1100 Anaheim, CA 92806 INSURER(S)R AFFORDING COVERAGE NAIC # — -- -- INSURER A: Lloyds of London FOREGN INSURED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INSURER B: Cordoba Corporation INSR LTR TYPE OF INSURANCE _ 1401 N. Broadway SUBR WVD INSURER C: POLICY EFF MM/DD/YYYY Los Angeles, CA 90012 LIMITS INSURER D GENERAL LIABILITY INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: R1=VISIr1N NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE _ ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE AEAG ETO a EocE ence $ MED EXP (Any one person) _ $ CLAIMS -MADE OCCUR PERSONAL &ADV INJURY $ GENERAL AGGREGATE _ $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG _ POLICY PRO- LOC JECT _$___ $ AUTOMOBILE _ LIABILITY COMBINED SINGLE LIMIT Ea accident $_ _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS _AUTOS PROPERTY DAMAGE Per accidents,,_,__ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE - $ ---._--- EXCESS LIAB CLAIMS -MADE -- --- --- ------ -......._._----.......-- $ DED _ RETENTION $ —_ WORKERS COMPENSATION _ WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N/A TORY LIMITSR E.L. EACH ACCIDENT ��----- - $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under -------- DESCRIPTION OF OPERATIONS below _ _ _ E.L. DISEASE - POLICY _ _ A Professional Liab B0621PCOR03214 09/27/2014 09/27/2015 $3,000,000 Per Claim/Ag Ded: $25,000 Per Claim DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Verification of Insurance Desl9ll Ely- ;'l'V U36 --gage A/ CORDOBA CORPORATION AGREEMENT A-2011-193-04 REVIEWED BY: EIJNIC;E HEREDIA AIDC d OF 6) CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S12993581/M12993558 LXMCN