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A6 RH CERTIFICATE OF LIABILITY INSURANCE
<br />00ATE (MMiDDIYYYY)
<br />6/22/2016
<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 />Denise K Hudson Insurance Agency, Inc
<br />ss ss License # OB86530
<br />SSH &B�iYflf
<br />1045 W Katella Ave Ste 240
<br />4 Orange, CA 92867
<br />CONTACT LORRIE SASAN
<br />_NAME; E -- - - -— FAx --
<br />J.41C No ai 3 &6118 A/c x,714 633 3720
<br />EMAIL
<br />rrie@
<br />ADDRESS /orris @denlsekhudson.com
<br />— - -.- —. ...-
<br />INSURERjSJ FFORDING COVERAGE Hall
<br />INSURER A State Farm General Insurance Company
<br />Y
<br />—_— ..._..._.. —_
<br />INSURED WESTERN AA/ INC
<br />INSURER6 State Farm Mutual Automobile Insurance Company
<br />_
<br />26178
<br />1592 N BATAVIA ST STE 2
<br />ORANGE, CA 92867
<br />INSURER C
<br />-----_...—...__..._._......._.._....__....._......._..._.._..._..._.........__.._----_.._.......__..._._—
<br />INSURERD:
<br />_�I
<br />INSURER E :
<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 TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />'TYPE OF INSURANCE
<br />IAHOL SUER
<br />IN SO VD
<br />POLICY NUMBER
<br />POLICY EFF-1
<br />MMIDDIYYYV
<br />POLICY EXP
<br />MMIOOIYYYY
<br />T ..__._.._ .... ___.
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />92 -EX- 5166.6
<br />0511612016
<br />0511612017
<br />EACH OCCURRENCE_
<br />$ 2,000,000
<br />CLAIMS -MADE JOCCUR
<br />�PkEM 9ESEoo,.cicugDcnae
<br />$ 300,000
<br />MED EXP (Any . ono person)
<br />$ 5,000
<br />PER bONAL&ADVINJURV
<br />$ 1,000000
<br />GENERAL AGGREGATE
<br />$ 4,000000
<br />GENLAGGREGATE
<br />UMITAPPLIES PER
<br />l
<br />r-
<br />POLICY —.] JECT �� LOC
<br />_...
<br />PRODUCTS- COMP /OP AGO
<br />$ 4,000000
<br />OTHER:
<br />iBUSINESS PROP
<br />$ 230,100
<br />B
<br />AUTOMOBILE LIABILITY
<br />375 9392- F17 -75P
<br />06!1712016
<br />1211712016
<br />COMBINED SINGLE LIMIT
<br />(Ea acclpenu,
<br />$ 1,000,000
<br />M ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />___
<br />ALL OWNED aChIEDULED
<br />X AUTOS X AUTOS
<br />. X I HIRED AUTOS .X AOT SWNED
<br />_
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(PCraccWont)__
<br />$
<br />$
<br />/\
<br />x UMBRELLA LIAR X OCCUR
<br />I
<br />92- XC- 0351.6
<br />1211412015
<br />12/14/2016
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$
<br />1 EXCESS LIAB iCLAIMS-MADE
<br />DED RE TEN TION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOWPARTNER /EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? �1
<br />i(Mandarory In NH) --
<br />jif yes,de.cnle.under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />92 -L4- 6790.1
<br />(
<br />0110112016
<br />01/01/2017
<br />X PTATUTE ERH
<br />EL EACH ACCIDENT
<br />- - - - —-
<br />.EL. DISEASE EA EMPLOYE
<br />.... -.... _.._........_ —. __
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />- - -_. ......_....
<br />$ 1,000000
<br />_ _.__......_......._......_.
<br />$ 1,000,000
<br />I
<br />j
<br />i
<br />I
<br />I
<br />I
<br />j
<br />j
<br />I
<br />I
<br />I
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attached if more apace is required)
<br />AUDIO VISUAL SERVICE & INSTALLATION
<br />Business Location #1 6353 Corte Del Abeto, Suite 106, Carlsbad, CA 92011 /Business Location #2 1592 N Batavia St., Ste 2, Orange, CA 92867
<br />Certificate Holder, City of Santa Ana, its officers, employees, agents, volunteers & representatives are additional insured
<br />REVIEWED BY: EUNICE HEREDIA (PG y OF y)
<br />CERTIFICATE HOLDER CANCELLATION
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02 -04 -2014
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92701
<br />--
<br />AUTIibRIZEO REPRESENTATIVE
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02 -04 -2014
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