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CALIFBI OF ID: WS
<br />CERTIFICATE OF LIABILITY INSURANCE DA 081181201TE 'YI
<br />0 811 812 01 5
<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), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 />INSURED
<br />Insurance Agency
<br />1550 East St. Gertrude
<br />Santa Ana, CA 92705
<br />Walt Storch
<br />E,tL10-207.9796 _ _ AIC NR): 310-207-5337
<br />INSURERS) AFFORDING COVERAGE NAICH
<br />:Ironshore Specialty Ins Co.
<br />National Union Fire Ins. Co.
<br />State Compensation Ins. Fund
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 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 />INSRODL'SUBRi POLICY EFF POLICY EXP
<br />LTR --
<br />LTR TYPE OF INSURANCE POLICY NUMBER MMIODIYYVV MMIDDM'YY LIMITS
<br />GENERAL LIABILITY
<br />Y
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PRCSA
<br />EACH OCCURRENCE $ 1,000,000
<br />A 'rX COMMERCIAL GENERAL LIABILITY
<br />Santa Ana, CA 92701
<br />TXX $0047502
<br />07/01/2015
<br />07/01/2016
<br />DAMAGE
<br />PREMISES (Ea occurrence _$__ 50,000
<br />CLAIMS -MADE CI OCCUR
<br />MED EXP (Any one person) . $ 5,000
<br />III
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />X Agg per project
<br />GENERAL AGGREGATE I$ 2,000,000
<br />PRODUCTS - COMPIOP AGG'$
<br />2,000,000
<br />GEN'L AGO REGATELI M IT APPLIESPER:
<br />I
<br />X POLICY PRO �'. LOC
<br />Emp Ben. t5
<br />1,000,000
<br />AUTOMOBILE
<br />LIABILITY -
<br />!, -
<br />COMBIN EO SINGLE LIMIT
<br />(Ea acc!dent1
<br />$ 1,000+000
<br />$
<br />B X
<br />ANY AUTO
<br />X ACPBA3006735836
<br />07/01/2015 07/01/20161 BODILY INJURY (Per person)
<br />ALL OWNED SCHEDULED1
<br />AUTOS AUTOS
<br />i '�, BODILY INJURY (Per accident)
<br />$
<br />$
<br />NON -OWNED
<br />PROPERTY PROPERTY DAMAGE
<br />HIRED AUTOS AUTOS
<br />j
<br />PERACCIDENT
<br />$
<br />X
<br />UMBRELLA LIAS OCCUR
<br />IBE047721473
<br />� EACH OCCURRENCE
<br />$ 5,000,000
<br />C
<br />X
<br />EXCESS LIAR CLAIMS-MADEI X
<br />II
<br />07/01/2015
<br />I 07101/2016
<br />AGGREGATE
<br />$ 5,000,000
<br />$
<br />DEO X RETENTION$ nil
<br />WORKERS COMPENSATION
<br />!, -
<br />X WC STATU' OTH-
<br />TORY LIMITS ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />_
<br />EL EACH ACCIDENT
<br />D
<br />ANY PROPRIETORIPARTNER/EXECUTIVE '., X
<br />906360815 07/01/2015!,
<br />07/01/2016
<br />$ 1,000,000
<br />OFFICERIMEMBER EXCLUDED? NIA
<br />(Mandatory in NH)
<br />$ 1,000,000
<br />__
<br />E L. DISEASE_ EA EMPLOYEE,
<br />If yyes, describe under
<br />DESCRIPTIONOFOPERATIONS below
<br />--
<br />E. DISEASE-POLICYLIMIT
<br />.$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />certificate holder, its officers, agents, and employee are named as
<br />additional insureds per CG20370413 Automobile A1: AC01 01 03 01. Waiver ��^^ e�a5
<br />subrogation per CG24000509 d \
<br />J G
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYSA3
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Y
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PRCSA
<br />20 Civic Center Plaza - M23
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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