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AAL <br />CERTIFICATE OF LIABILITY INSURANCE R002 <br />DATH(MM /UD(YYY'Y) <br />5/5/2016 <br />THIS CERTIFICATEIS 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />BIN INSURANCE HOLDINGS LLC /PHS <br />505500 P: (866) 467 -8730 F: (888) 443 -6112 <br />PO BOX 33015 <br />SAN ANTONIO TX 78265 <br />CONTACT <br />NAME: <br />�A//C,N,Ext): (866) 467 -8730 <br />a,Ne): (888) 443 -6112 <br />ADDRESS: <br />INSURERS) AFFORDING COVERAGE NAIC8 <br />INSURER A: Sentinel Ins Co LTD <br />LIJUT.S <br />INSURED <br />HJELMSTROM & ASSOCIATES <br />25072 WILKES PL <br />LAGUNA HILLS CA 92653 <br />INSURER B <br />COMMERCIAL GENERAL LIABILITY <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />EACH OCCURRENCE <br />INSURER F: <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 <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LVSR <br />LTR <br />TYPE OF F.VSUR +V(E <br />ADDL <br />V' <br />SUBR <br />POLICTA'VAIRER <br />POLICYEFF <br />(3Lf11DD1Y)TI) <br />POI.ICy LYP <br />b4 J <br />LIJUT.S <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$1, 000, 0 0 0 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />1 000, <br />$1, 0 0 0 <br />X <br />X <br />VIED EXP (Any one person) <br />"10,000 <br />A <br />General Liab <br />46 SBM UM3801 <br />04/16/2016 <br />04/16/2017 <br />PERSONAL & ADV INJURY <br />$1, 0 0 0, 000 <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />s2, 0 0 0 , 000 <br />GEN'L <br />POLICY F—] JE a LOC <br />PRODUCTS - COMP /OP AGG <br />s2, 00-0, 0 0 0 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY (Per person) <br />,$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />HIRED NON -OWNED <br />PROPERTY DAMAGE <br />AUTOS ONLY AUTOS ONLY <br />(Per accident) <br />S <br />UMBRELLA LIAR <br />EACH OCCURRENCE <br />EXCESS LIAB <br />HOCCUR <br />CLAIMS -MADE <br />AGGREGATE <br />c <br />DED RETENTION S <br />If ORXERSC'OMI 'NSATION <br />AND EMPLOYF-RS'LIABILITY <br />PER OTH- <br />STATUTE I JER <br />E.L. EACH ACCIDENT <br />c <br />ANY PROPRIETOR /PARTNER /EXECUTIVE Y/N <br />OFFICER /MEMBER EXCLUDED? <br />(Mandatory In NH) ❑ <br />N,A <br />E.L. DISEASE- EA EMPLOYEE <br />_.... <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. Please see Additional Remarks <br />Schedule Acord Form 101 attached. <br />� <br />f 1 <br />REVIEWED BY:. LL EUNICE H RC D[A (PG r O F �......J <br />CERTIFICATE HOLDER CANCELLATION <br />U 1985 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />City of Santa Ana <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Purchasing Department <br />AUTHORIZED REPRESENTATIVE <br />20 CIVIC CENTER PLZ <br />SANTA ANA, CA 92701 <br />J / <br />U 1985 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />