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® ACC) ® CERTIFICATE OF LIABILITY INSURANCE OATE(MMIODPYYYY) 1/21/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER GLENN A LEVINE 104 Cloudcrest Aliso Viejo, CA 92656 NAME: _ PHONE ac N Ext1', (714) 865 -1408 _ FAX Not(949) 305 -0266 A60 "a'Ess:galinsurance @yahoo.com INSURER(Sh AFFORDING COVERAGE NAICN _ INSURER A: CYPRESS INSURANCE COMPANY 10855 INSURED NDT INC. S KNOWLWOOD ENTERPRISES, INC. DSA: KNOWLWOOD 17654 NEWHOPE ST. SUITE H FOUNTAIN VALLEY, CA 92708 714 429 9356 INSURER B. INSURER C: INSURER D. INSURER E'. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE PERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ irn TYPE OF INSURANCE AINSD VWD POLICY NUMBER MMID�� MM%DCNYVV LIMITS it - -- COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR � EACH OCCURRENCE $ AGE PREMISES (Ea occurrence ) $ _ MED EXP (Any one person) $ GENL AGGREGATE LIMIT APPLIES PER: POLICY JECOT D LOO OTHER: PERSONAL BADV INJURY GENERAL AGGREGATE _$ $ PRODUCTS - COMPIOPA_G_G $ $ AUTOMOBILE LIABILITY _ ANVAUTO ALL OWNED SCHEDULED _ AUTOS AUTOS _ HIRED AUTOS _ AUTOS n��QU ,� p ,\� C �.r �� (� i Ea accidenq $ BODILY INJURY (Par person) $ BBOODIILY NJURY(PParE. dl $$ -- Peramident - $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE a Q EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION IAND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/E%ECUTIVE ❑ OFFICERIMEMBER E%CWDEOI Y (Man4ewry in NRI DESCRIPTION under I yes, CRIPTION OFO OPERATIONS below NIA KAIWC 609938 02/01/2015 02/01/2016 j[ - STATUTE ER E L, EACH ACCIDENT $ 1,000,000 _ E . DISEASE - EA EMPLOYE $ 1,000 , 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ITHE INSURED OPERATES A RESTAURANT LOCATED AT 1801 E. CHESTNUT AVE., SANTA ANA, CA 92701 I THE CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2O CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 '. AUTHORIZED REPRESENTATIVE © 1988 -2014 ACORf D/CCOf `RPOt RRA`ATT'IOON..� All rights reserved. ACORD25 (2014/01) The ACORD name and logo are registered marks of ACORD