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A� ®� CERTIFICATE OF LIABILITY INSURANCE <br />ATE <br />7/13/2015 v) <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(los) 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 />PRODUCER <br />CNAME:ONTACT Justine Bustillos <br />Southern California Insurance Brokerage <br />IPHONE ,(909)592-2215 rax <br />-Mol.(909)305-0391 <br />10670 Civic Center Drive #210 <br />EMAIL <br />ADDRESS:0uatine@socalinsurance.com <br />License #0177159 <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURERA:State Compensation Ins. Fund <br />35076 <br />Rancho Cucamonga CA 91730 <br />INSURED <br />INSURER B <br />PRODUCTS - COMP/OP AGS $ <br />INSURERC: <br />DD Systems, Inc., DBA: ACE CD, inc. <br />INSURER D: <br />1199 Englewild Dr. <br />INSURER E <br />INSURER F: <br />BODILY INJURY (Per person) $ <br />Glendora CA 91741 <br />COVERAGES CERTIFICATE NUMBER:15/16 WC RENEWAL 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 />INSR <br />LTR <br />TYPE OF <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDNWY) <br />POLICY EXP <br />(MMIDDIYYYYI <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITYDAMAGE <br />CLAIMS -MADE ❑ OCCUR <br />ROSE ANNEX (M-22) <br />SANTA ANA, CA 92701 <br />Diana Kubo, CISR/CMR <br />EACH OCCURRENCE $ <br />Toft TED <br />PREMISES E.occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL &ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO JPCT 71 LOC <br />PRODUCTS - COMP/OP AGS $ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />COMBINED SINGLE LIMIT <br />Ea..,dent <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accldenry $ <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAROCCUR <br />EXCESS LIAR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNEWEXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS be. <br />NIA <br />9098335-15 <br />3/1/2015 <br />3/1/2016 <br />WC STATU- OTH- <br />X V <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E. L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E. L. DISEASE -POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />RE: ALL CA. OPERATIONS <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2010/05) <br />INR025 (vnlnme m <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />Th. ArVn!Pn ......A Innn ar. r.ni.t.rcrl mar4. of Af r)Pn <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 />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA - <br />AUTHORIZED REPRESENTATIVE <br />ROSE ANNEX (M-22) <br />SANTA ANA, CA 92701 <br />Diana Kubo, CISR/CMR <br />ACORD 25 (2010/05) <br />INR025 (vnlnme m <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />Th. ArVn!Pn ......A Innn ar. r.ni.t.rcrl mar4. of Af r)Pn <br />