Laserfiche WebLink
.� DATE(MMIODiYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 11/28/2016 <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 INSURERS), 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, su6Jec# 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 />PRODUCER <br />AM .( <br />EMPLICITY INSURANCE SERVICES <br />9851 Irvine Center Driveo..N;(943) 716-5353 <br />ORES3: <br />Irvine, CA 92618 <br />fNSUnER(a} AFPORLING COVFRAt}E NAI06 <br />INSURER A' <br />INSURED THE ILLUMINATION FOUNDATIONINSURIER B: State Compensa a.on Insura.cea Fund <br />2691 Richter Ave., Suite 107 INSURER <br />Irvine, CA 90606 INSURER D: <br />INSURER E <br />11dQI Mr:p r; <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 />8R <br />.LTR <br />_....._..._..�..PE, -..-.. <br />TYPF GF INSURANCE <br />ADOL <br />INSO <br />'JOSH <br />WVa. <br />.. <br />POI -ICY NUMBER <br />- <br />�� Pt)L1GY EFF <br />(MMJDDfYYYY <br />FULIGY -EXP <br />MMfDDNiW) <br />LlhllTS <br />COMMERCIAL GENERAL, LIAB[i,€TY <br />EACH OCCURRENCE <br />S. <br />..».....:� <br />CLAIMS -MADE COCUR <br />fTYE <br />PF�EMr38S:.a <br />S <br />MED EXP (Any ono person) <br />$ <br />PERSONALe,ADVINJURY <br />$ <br />CENT AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />S <br />POLICY EI 4, T I LOC <br />I <br />PRODLICTS - COMPIOP AGG <br />$ <br />O-f7lER; <br />� <br />... <br />S <br />. <br />AUTOMOBILE <br />LIABILITY <br />I <br />_-_ <br />QMRS4s'jNEIJkSINGLE jfiiiff�— <br />$ <br />ANYAUTO <br />UODILY INJURY (Par person) <br />S » <br />ALL OWNED SCHEDULED <br />BODILY INJURY (Par accident) <br />$ <br />AUTOS AUTOS <br />NON-oWNCD <br />HIRED AUTOS �; AUTOSi?�i <br />—(Jddord <br />$ <br />I <br />UMBRELLA LIA6OCCUR <br />i <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE <br />3 <br />DED RETENTiON$„3 <br />WORKERS COMPENSATION <br />! <br />x STATUTE ER <br />AND CMPLOYERS' LIA81UTYIN <br />yL <br />1,000 000. <br />A <br />ANY PROPRiETOR1PARTNER1FXECl1TtVE <br />FXCLUDFD4 <br />NrA <br />E.L. EACH ACCIDENT <br />$ <br />OFFICERIVEMOFR <br />(Mnrtdanry In NHl f <br />I <br />9040950-16 <br />1/1/16 <br />1/1/17 <br />FF,L,ISEASE-EA EMPLOYE <br />E1 0001004V <br />yesdss0be underDESCRIPTIONOFOPERATi0N3bolDw <br />SEASE-POLICYLIMIT <br />S 1,000,0001 <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />CERTIFICATE HOLDER <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE <br />CANCELLED BEFORE i <br />Cit � StAna <br />City OSanta <br />THE EXPIRATION DATE THEREOF, NOTICE WILL <br />BE DELIVERED IN i <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza M-25 <br />Santa Aria, CA 92701 <br />AUTHORIZED REPRESENTATIVE � <br />(9 1 UtSti-ZU14 AUUKU L;UNJ UKA i IUN. Ali rignts reserved. <br />ACOIRD25(2014101) The ACORD name and logo are registered marks ofACORD A <br />