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Policy Number: 613- 00 -28 -44 -0000 Date Entered: 7/14/2016 ACO/2L7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYV) 7/14/2016 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 pollcy(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 MCIS 13700 TAHITI WAY 0244 MARINA DEL REY, CA 90292 NAME: LOLITA SAMARINI AICNEO Ext: (310)390-0777 AID No: (310)390 -0222 E -MAIL LOLITA@MANATEKINS.COM ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N LOLITA SAMARINI e_ INSURER A: ATLANTIC SPECIALTY INSURANCE COMPANY 27154 INSURED FMG, INC. INSURER B: $ 1 INSURER C: CLAIMSNADE Ix OCCUR DBA: HADLEY TOW & HADLEY INSURER D: 11819 - 11827 E. HADLEY ST. WHITTIER, CA 90601 INSURER E: DAMAGE HIEN I ED PREMISES OEa occurrence INSURER F : MED ESP (Any one person) 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDLSUBR B POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYY LIMITS A SANTA ANA, CA 92701 -4010 COMMERCIAL GENERAL LIABILITY LOLITA SAMARINI e_ EACH OCCURRENCE $ 1 CLAIMSNADE Ix OCCUR x DAMAGE HIEN I ED PREMISES OEa occurrence $ 100,000 MED ESP (Any one person) $ 613- 00 -28 -44 -0000 12/15/2015 12/15/2016 PERSONAL A ADV INJURY $ 1,000,000 AGGREGATE GATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2 OQQ 0 GEHL R POLICY u PRO- ® LOD PRODUCTS - COMPIOP ADS $ 2,000,000 IS OTHER: AUTOMOBILE LIABILITY ANY AUTO X COMBINED SINGLE LIMIT Ea accldenl $ BODILY INJURY (Par Person) $ ALL OWNED SCHEDULED AUTOS _ AUTOS 613- 00 -28 -44 -0000 12/15/2015 12/15/2016 BODILY INJURY(PSracoldent) $ PROPERTY DAMAGE Per accident $ A NON -OWNED HIRED AUTOS AUTOS $ UM F K UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS MADE DEO RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) Ilyes, describe must DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ A ON HOOK 613- 00 -28 -44 -0000 12/15/2015 12/15/2016 $100,000 $2,500K DED. A PHYSICAL DAMAGE 613- 00 -28 -44 -0000 12/15/2015 12/15/2016 COMP. & COLL. $2,500K DED. 12/15/2015 12/15/2016 $1,000,000 $500/$2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Atlditlonal Remarks Schedule, maybe attached it more space is required) CERTIFICATE HOLDER IS AN ADDITIONAL INSURED WITH RESPECTS TO LIABILITY ARISING FROM THE OPERTATIONS OF THE NAMED INSURED OPERATIONS. Location # 2 - 12793 Garvey Ave, Baldwin Park, CA 91706 /Location # 3 - 1090 N. Parker St, Orange, CA 92867 Location # 4 -1343 Logan Ave. Costa Mesa CA. 92626 /Location # 5 - 15176 Whittram Ave, Fontana, CA 92334 / Location # 6 - 201 S. Balcom Ave, Fullerton, CA 92832 CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES AGENTS & REPRESENTATIVES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: PURCHASING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS, 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE Per �) JIJt/ s SANTA ANA, CA 92701 -4010 LOLITA SAMARINI e_ D. © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ww ACORD Pmducedusing Forms Boss Plus soNware. w. FomrrB05a ,00mlmpresslvePublishing 800 -20 &7977