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A r�CERTIFICATE OF LIABILITY INSURANCE
<br />ATE
<br />01/04/2017
<br />D01/04/D2017j
<br />PRODUCER
<br />STAT SURANCE - JOHN LUITHLY
<br />16277 @CANYON RD STE F
<br />IRVINE, CA 92618-4011
<br />THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />ELIZABETH M KILEY INC
<br />DBA KILEY COMPANY
<br />2151 MICHELSON DR STE 205
<br />IRVINE, CA 92612
<br />INSURERA:State Farm General Insurance Company 25151
<br />25151
<br />INSURERB:State Farm Mutual Auto Insurance Company 25178
<br />AUTHORIZED REPRESE ATI E
<br />INSURERC:State Farm Fire and Casualty Company 25143
<br />INSRD
<br />INSURER D:
<br />POLICY NUMBER
<br />INSURER E:
<br />DATE MM1D0fYY
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />ADDI
<br />ITS OFFICERS, EMPLOYEES & AGENTS
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />POLICY EFFECTIVE
<br />POLICY EXPIRATION
<br />AUTHORIZED REPRESE ATI E
<br />LTR
<br />INSRD
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />DATE MMiODNY
<br />DATE MM1D0fYY
<br />LIMITS
<br />A
<br />X
<br />GENERAL LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />92 -C9 -V665-7
<br />06/01/16
<br />06/01/17
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE R IEb
<br />PREMISES Ea occurrence)
<br />$ 2 000,000
<br />CLAIMS MADE OCCUR
<br />MED EXP An one arson
<br />$ w 5,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />GENL AGGREGATE LIMITAPPLIES PER
<br />PRODUCTS -COMPIOPAGG
<br />$
<br />PRO -
<br />POLICY JECT M LOC
<br />B
<br />X
<br />AUTOMOBILE
<br />LIABILITY
<br />085 9537-BO1-7517
<br />06/01/16
<br />02/01/17
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />ANY AUTO
<br />2014 MERCEDES
<br />—
<br />X
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />WDDLJ7DB5EA100763
<br />BODILY INJURY
<br />(Per parson)
<br />$ 1,000,000
<br />BODILY INJURY
<br />(Per accident)
<br />$ 1,000"000
<br />X
<br />X
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />YtDAMAGE
<br />PROPERTY
<br />$ 1,000,000
<br />X
<br />COMP DED - $500
<br />X LOLL DED - $500
<br />GARAGE LIABILITY
<br />AUTO ONLY -EA ACCIDENT
<br />S
<br />OTHER THAN EA ACC
<br />$
<br />ANY AUTO
<br />$
<br />AUTO ONLY;
<br />AGO
<br />A
<br />X
<br />EXCESSIUMBRELLA LIABILITY
<br />75 -CD -2498-7
<br />08/02/16
<br />08/02/17
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$
<br />OCCUR F -I CLAIMS MADE
<br />$
<br />$
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />C
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEPJEXECU11VE
<br />92 -CX -L783-0
<br />09/01/16
<br />09/01/17
<br />X W - oTII-
<br />TORRYYIMI
<br />LLIMITS F.R
<br />E.L. EACH ACCIDENT
<br />$ 11000,000
<br />E.LDISEASE- EAEMPLOYEE
<br />$ 1,000,000
<br />OFFICERlMEMBEREXCLUDED?
<br />NIf yyes, describe under
<br />SPECIAL PROVISIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $ 1,000,000
<br />OTHER
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />CERTIFICATE AND ADDITIONAL INSURED COVERS AGREEMENT ##A-2015-155 AND A-2011-068 AND A-2016-285
<br />REVIEWED WED EY: EUNIt E R 9ER D) A (PG C "'�F �
<br />rPPTIFICATG HOLDER CANCELLATION
<br />ADDITIONAL, INSURED:
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 90 DAYS WRITTEN
<br />CITY OF SANTA ANA
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
<br />ITS OFFICERS, EMPLOYEES & AGENTS
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />C/O ROSS ANNEX
<br />REPRESENTATIVES.
<br />AUTHORIZED REPRESE ATI E
<br />20 CIVIC CENTER PLZ
<br />SANTA ANA, CA 92701
<br />JOHN LUITHLY
<br />ACCORD 25 (2001108) 1 ne registration notices inelcate ownership DI me marks by Limm iespvupva vVV11twz, c, W. ,., .,,,r,,W,:,u1,, ..u,,,
<br />132849 03.13.2007 All rights reserved
<br />
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