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-�1 BELLB-1 OP ID: SO <br />GERTIF r,�ATE OF LIABILITY INS.�RANCE DATpMMIDDI5YY) <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 />Inc. (M) <br />636 <br />e.110 <br />Phone: <br />Fax: <br />Ortiz <br />—_- )arc IN 951-297-2415 <br />IBmeuua,4A CLOY I <br />Ed Hollander <br />-_. - _ — -... __ __. _._- <br />INSURER(S)AFFORDINGCOVERAGE NAIC4 <br />INSU_RERA:A_mTrustInternational <br />INSURED Bell BuildingMaintenance Co. <br />- - -_ <br />wsuREZB:Oak River Insurance Company_ 34630 <br />Mrs. Yang Chanhee <br />5170 Sepulveda Blvd., #180 <br />_ -_ <br />INSURER C: <br />ShermanOaks, CA 91403 <br />INSURERD: <br />A-1J'-i.�itf <br />INSURERS:.... <br />INSURER F : <br />COVFRAGES CERTIFICATE NUMBER: <br />REVISION NUMBER: 1 <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 <br />DOCUMENT WITH RESPECT TO WHICH <br />THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED <br />HEREIN IS SUBJECT TO ALL THE PERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IL- --_. - SBA C308� _....... _.. _.. L Y EFF POLICY EXP <br />; MMIDDIYYYY iYYYY <br />TRR; TYPE OF INSURANCE ''INSR_LW POLICY NUMBER MMtOD <br />... -_ <br />LIMITS <br />I GENERAL LIABILITY II <br />EACH OCCURRENCE $ <br />1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY X X EN102474100 01110/15 j 01/10/16 <br />O A E T RENTED <br />PREMISES (Ea occurrence) '$ <br />_ <br />100,000 <br />CLAIMS -MADE X OCCUR <br />MED EXP (Any one person) s <br />6,000 <br />� .. _�I <br />I <br />PERSONAL&ADV INJURY I g <br />1,000,000 <br />GENERAL AGGREGATE. <br />2,000,00 <br />GENI, AGGREGATE LIMIT APPLIES PER: <br />(PRODUCTS - COMP/OP AGG $ <br />1,000,00 <br />X POLICY PRO. .__ <br />LOC <br />JECT �... .:........Irt t*, <br />...._ <br />$ <br />'. AUTOMOBILE LIABILITY '... ! <br />COMBINEU SINGLE LIMIT <br />(Ea accident)_ $ <br />_. <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />ALL OWNED—, SCHEDULED <br />l [ AUTOS AUTOS ( <br />.BODILY INJURY(Po[acddenq $ <br />- <br />- - <br />....1 NON OWNED <br />! (HIRED AUTOS <br />Silvia Cuevas <br />PROPERTY DAMAGt <br />_'Para—dsn?} $ <br />__.AUTOS <br />UMBRELLA LIAB <br />EACH OCCURRENCE is <br />OCCUR MADE'. <br />EXCESS LIAB <br />AGGREGATE $ <br />LIED RETENTION.$ <br />$ <br />- WORKERS COMPENSATION ! <br />X WC STATU- OTH-'I <br />- AND EMPLOYERS LIABILITY YIN <br />B % ANY PROPRIErORlPAftrhIERtEx£CUTIVE !2200066789-141 05102114 06102115 <br />( <br />� <br />TORY LIMIT$ �T_. <br />E.L. EACH ACCIDENT • $ <br />1,000,00 <br />— <br />OFFICER(MEMBER EXCLUDED? .IN <br />(Mandatory in NH) <br />E L DISEASE EA EMPLOYEE $ <br />1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS beow l <br />EL DISEASE - POLICY LIMIT $ <br />1,000,000 <br />DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES (Attach ACORD 101, Addittonal Remarks Sebadulel, d more space Is required) <br />Certificate holder, its officers, employees, agents, and representatives are <br />named as Additional Insured in regards to the general liability where <br />required by written contract, with primary and non-contributory wording in <br />respects to the operations of the Name Insured. <br />CITYOFS <br />City of Santa Ana <br />Parks, Recreation and <br />Community Services <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <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 />@ 1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD <br />