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/Re VIz'-'Ved I MINIO LIe_
<br />A 5, % CERTIFICATE OF LIABILITY INSURANCE DATE, MOO DNYYYI
<br />5/14/2015
<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(S), AUTHORIZ'E'D
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain-poilcies may require an endorsement. A -statement on this certificate -does -not confer rights to the - --
<br />PRODUCER
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />NgM.O D1Annd Martin
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />All -Cal Insurance Agency
<br />INSrF
<br />TYPEOFINSURANCE - ADDL SUaR__-- INSO WyePOLICY NUMBER MGIOC ''� Id�IDNYYYY
<br />_
<br />SON Enq (916)764-9070, FAX No): (916)
<br />...,.
<br />784-0358
<br />505 Vernon Street
<br />pRES5. dianna@ all-Calinsurance. COR,
<br />A CLAIMS MADE X OCCUR
<br />PREMISES (R ONCE rS(Eeo S.
<br />X LIQUOR LIABILITY i X - 2015-0e609NP0 5/13/2015 ',. 6/13/2016
<br />INSURERISI AFFORDING COVERAGE
<br />NAM &
<br />Roseville CA
<br />95678
<br />INSURERA NonprofitsI Insurance Alliance of.
<br />011645.___
<br />INSURED
<br />JECT
<br />INSURERB:StateCompensatlon Insurance Fund
<br />35076
<br />Los Angeles Dream Shapers
<br />:,
<br />INSURERD•
<br />AUTOMOBILE LIABILITY
<br />P.O. BOX 3831
<br />INSURER D: _.__
<br />.. -....
<br />._....... ._.. ___ .........._
<br />ALL CYNED SCHEDULED - 6/13/2016
<br />8015-G 864°meo 6/13/2015
<br />INSURERE.. _
<br />AUTOS AUTOS
<br />NON OWNEU
<br />Orange CA
<br />82865
<br />ISURERF:
<br />nnVERAr_cc
<br />r^CpTwIrATG WIMRFR,CL1551304518 REVISION NUMBER:
<br />EACH OCCURRENCE $..
<br />V THIS IS '10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />- -
<br />INSrF
<br />TYPEOFINSURANCE - ADDL SUaR__-- INSO WyePOLICY NUMBER MGIOC ''� Id�IDNYYYY
<br />LIMITS
<br />IX COMMERCIAL GENERAL LIABILITY - ! :
<br />EACH OCCURRENCE ..S 1,000,000
<br />DAMAGETo EDanee) 500,000
<br />A CLAIMS MADE X OCCUR
<br />PREMISES (R ONCE rS(Eeo S.
<br />X LIQUOR LIABILITY i X - 2015-0e609NP0 5/13/2015 ',. 6/13/2016
<br />MED EXP (Any oneprson) S _ 20,000
<br />$ 1,000,000 / 1,000,000 -
<br />PERSONALS ADVINJURY $, 1,000,000
<br />GEN'LAGGRECATE UPAITAPPLIES PER: ',.GENERAL
<br />AGGREGATE S 2,000,000
<br />-' PRO. -. LDC
<br />X 'POLICY
<br />PRODUCTS CDMP/OF AGG $ 2,000,000
<br />JECT
<br />$
<br />OTHER' -
<br />:,
<br />COMBINED SINGLE LMUr $ 1,000,000
<br />AUTOMOBILE LIABILITY
<br />BODILY INJURY (Per p son) $
<br />A ANY AUTO
<br />._....... ._.. ___ .........._
<br />ALL CYNED SCHEDULED - 6/13/2016
<br />8015-G 864°meo 6/13/2015
<br />BODILY INJURY IPe ccltlent) $
<br />AUTOS AUTOS
<br />NON OWNEU
<br />PROPERTY DAMAGE $
<br />X HIRED AUTOS X AUTOS ,,fPRr
<br />ACc tlenp ..-
<br />UMBRELLALIAB OCCUR
<br />EACH OCCURRENCE $..
<br />EXCESS LIAR CLAIMS MADE,
<br />AGGREGATE S
<br />DED RETENTION -
<br />- S
<br />WORKERS COMPENSATION -
<br />X PER
<br />STATUTE OCH
<br />STATUTE.--
<br />AND EMPLOYERS' LIABILITY
<br />-
<br />_-
<br />ANY PROPRIETORIPARTNERIEXECUTIVL ;-"-;NIA
<br />E.L.EACH ACCIDENT .$ 1,000,000,
<br />OFFICERIMF.MBER EXCLUDED?
<br />$ _ 901532;-15 6/6/2015 6/6/2015
<br />(Mandaf9ry in NHi LEL
<br />DISEASE EA. EMPLOYEE $ _ 1,000,000
<br />If y55, tlasrri6e urtlor
<br />DESCRIPTION OF OPERATIONS below -
<br />E.L. DISEASE -POLICY LIMIT:$ 1,000,000
<br />DESCRIPTION OF OPERATIONS (LOCATIONS I VEHICLES IACORD 101, AdtllllonRl Ranarke 5Chodula, may bR attached If morn space le regolred)
<br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED ADDITONAL INSURED UNDER
<br />THE TERMS OF THEIR CONTRACT. INSURANCE IS PRIMARTY AND NONCONTRISUTRY.
<br />FORM CG 20 10 APPLIES
<br />CITY OF SANTA ANA
<br />ATTN: PURCHASING DEPARTMENT
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701
<br />SIIOULD 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 />All rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 (2oi4w)
<br />
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