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/'^1f �� (°� f „�. ,. TUMS006 OP 10: E <br />A te" CERTIFICATE OF LIABILITY f 1VCE �06126ATE 12015Y, <br />06LDER. T I /I <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 c <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polioyp") 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 />INSURED <br />Jamie Boggeln <br />3632 Laurashawn Lane <br />Escondido, CA 92026 <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 />INBR LTR <br />TTPEOFINSURANGE _ <br />MqR <br />SMni 00 <br />POLICY NUMBER <br />MMDPOIJOYEFF <br />P Lp P <br />LIMITS <br />A <br />GENERALLIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑ OCCURMED <br />X <br />8094866902 <br />( <br />06/25/2016 <br />06)25/2016 <br />EACH OCCURRENCE $ 1,000,00 <br />300,00_0 <br />EXP IMycne eP fwnl S _Exclude <br />PERSONAL b AGV INJURY $ 1,000,000 <br />GENERALAGGREGATE If 3,000,00 <br />_ <br />GEN'LAGGREGATE <br />X POLICY <br />LIMIT APPLIES PER: <br />PRO- LOC <br />PRODUCTS -COMPIOP AGO S 1,000,00 <br />$ <br />AUTOMOBILE LABILITY <br />ANYAUTO <br />ED 'AUT6ULE0 <br />O <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />I <br />� <br />C OMBI aEBD SINGLE LIMIT <br />11 <br />—3 . —_ <br />-- <br />BODILY INJURY (Per pron) S <br />BODILY INJURY(P rw.dN$SOS <br />PROPERTY DAMAGE $ <br />RACCIDEN <br />$ <br />UMSRELLAUASOCCUR <br />EXCESS LWe <br />CIAIMB-MAGE <br />y <br />ryC, $,a <br />vv <br />EACHOCCURRENCE $ <br />AGGREGATE S <br />DED RETENTIONS <br />If <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABUTY YIN <br />ANY nPROPRIETORSPARTNERCUTIVE <br />OFFICERIMEMBER XCLUDEUF <br />Na, Seery In NH) <br />If 9Ba Aeembe umlBr <br />OrOF OPERATIONS below <br />NIA <br />) <br />VIC <br />C! <br />- <br />ST ATV- TH- <br />— <br />EL.EACHACCIDENT $ <br />EA. DISEASE-EA.EMPLOYEE$ <br />_ <br />E.L. DISEASE -P041GY LIMIT ''$ <br />B <br />Participant Excess <br />TEMP -P-103000465 <br />0612612015 <br />06/2612018 <br />Per. Acc. 25,00 <br />Ded 10 <br />DES MPnONOFOPEFATIONSILOCATIONSfVEHICLES (Altaoh ACORD101.A Ilion! Roma eSchetluie,Ifmoraapaceism4ulr.dI <br />The certificate holder is listed as additional insured: Officers, Agents and <br />EmPloyeas <br />CERTIFICATE HOLDER _... _ CANCELLATION_ <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Officers, Agents and Employees <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />