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DATE (MMIDONYYY)'.
<br />AC<>Rb'' CERTIFICATE OF LIABILITY INSURANCE 6/12/2017
<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(ies) 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 />Insurance Agency
<br />505 Vernon Street
<br />A.,CONTACT
<br />DAna
<br />MartinNkw.,.......
<br />-._0s
<br />POt(91 GNa} -.(916) 784
<br />6}7B4^90_
<br />7 0 ,
<br />158All-Cal
<br />E-MAIL S:dianna@alb.-ADDRESSJ`..- .�. ...
<br />INSUEtER[Sj AFFCRDINC, COVERAGE
<br />NAIC t'!
<br />Roseville CA 93678
<br />INSURER A i onprofits 'Insurance Alliance of
<br />011895
<br />INSURED _
<br />INSURER B;State Compensation Insurance Fuld
<br />35076
<br />INSURERC: �..
<br />MED EXP (Any one person)
<br />The Los Angeles Dream Shapers
<br />INSURER D!
<br />X.
<br />P.O, Bos 3831
<br />INSURER E:
<br />._._._
<br />2017-06609tYPP
<br />.........,....,� _-____„..
<br />INSURER F
<br />6/13/2018
<br />Orange CA 92865
<br />COVERAGES CERTIFICATE NtJMBER,CL1742506234 REVISION NUMBER:
<br />COVERAGES
<br />--- -
<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 />INDICATE -"•D. NOTVMTHSTANDING 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 />LTR
<br />TYPEL)FINSURANCt=
<br />X001SUBR
<br />�.-
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM
<br />POLICY EXP
<br />MMlDDYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />EACH OCCURRENCE
<br />DAMAGEY(Yt-"7°Tf=Z1y
<br />PREMISES Eaoccurrencs
<br />3 1,000,000
<br />$ 500,410
<br />MED EXP (Any one person)
<br />3 -..... 20,000
<br />X.
<br />I.I:QUOR LIABILITY
<br />$1,000,000/1,000,000
<br />X
<br />2017-06609tYPP
<br />611.3/'20,17'
<br />6/13/2018
<br />PERSONAL SADV INJURY
<br />$ 1,000,000
<br />-.--.
<br />GEN'L AGGREGATE LIMIT APPLtES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PROQUCTS-COMPdOPAGG
<br />S 2,000,^000
<br />X POLICY D PRI- LOC
<br />3ECT
<br />_ .-,_,.,_._
<br />OTHER_
<br />AUTOMOBILE LIABILITY
<br />II ED S10LE LIMIT—
<br />Ea COMBINED
<br />S 1, 000 , 000
<br />BODILY INJURY (Per person)
<br />$
<br />AANY
<br />AUTO
<br />ALL OVMED SCHEDULED
<br />HIRED AUTOS AUTtRS
<br />Ix AUTOSNOOt7lE6
<br />20,11-08609NPO
<br />COPff DED $500
<br />6/'13/2017
<br />6/1.3/2018
<br />BODILY INJURY (Per accident)
<br />S
<br />PROPER°rY DAMAGE _
<br />Pga acavfeni
<br />$
<br />M
<br />LOLL DED $500
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE,
<br />S
<br />EXCESS LIAR'
<br />'.....
<br />CLAIMS -MADE
<br />DED =RETENTION $,
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />9015327-17
<br />6/6/2017
<br />6/6/2018
<br />X PER 'hl -
<br />sTA7I;.TE ER,
<br />E.L.EACH ACCIDENT
<br />$ 1,000,000
<br />DISEASE - EA EMPLOYE -
<br />$ 1,000 000
<br />H
<br />OFFICERWEMBER EXCLUDED? �.
<br />(Mandatory in NH)
<br />N 1 A
<br />DISEASE -POLICY LIMIT
<br />$ ----11-0 010 000
<br />It yea, descaibe under DESCRIPTION OF OPERATIONS Beloit'
<br />--
<br />Is required)�-
<br />DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule,may be attached If more space rd
<br />.e ADDITIONAL iIR>;D
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES ARE N ADD
<br />IN REGARDS TO GENERAL LIABILITY. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY.,,\e
<br />FORM CG 20 10 APPLIES
<br />.✓
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIDNS.
<br />SANTA ANA, CA 92701
<br />..AUTHORIZED REPRESENTATIVE -
<br />Q 1988-2044 ACp 3 COR VRATION. Ali nights reserved.
<br />ACORD 25 (2014/0'1) The ACORD name and logo are registered marks of ACORD (/
<br />IN'S026 (201401)
<br />
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