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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIYYW) <br />09/14/2017 <br />PRODUCER <br />STATE -FARM INSURANCE - JOHN LUITHLY <br />192 TECHNOLOGY DR STE F <br />THIS CERTIFICATE IS ISSUED AS MATTER OF IN FORMATION <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 />IRVINE, CA 92618 <br />LIMITSA <br />ADDI POLICY EFFECTIVE POLICY EXPIRATIONLTR <br />INSRD TYPE OF INSURANCE EOLICY NUMBER DATE (MMIDDfYY) DATE (MMIDDIYY) <br />NOTICE TO THE CERTIFICATE HOLDER NAMED - E LEFT, BUTFAILURETC, DOSO SHALL <br />X <br />GENERAL LIABILITY <br />INSURED <br />IN-SURERA: State Farm General Insurance Companv 25151 <br />2Si5l <br />INSURERB: State Farm Mutual Auto Insurance Company 25178 <br />PRE ISES (Ea occurrence) $ 2,000,000]CLAIMSMADE <br />ELIZABETH M KILEY INC <br />DBA KILEY COMPANY <br />INSURERC: State Farm Fire and Casualty Company 25143 <br />JOHN LUITHLY <br />2151 MICHELSON DR STE 205 <br />INSURER D: <br />INSURER E: <br />IRVINE, CA 92612 <br />ctm/I-x.//cnvLU=" <br />OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY <br />THE POLICIES <br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED ORMAY <br />REQUIREMENT, <br />INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCHPOLICIES. <br />PERTAIN, THE <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSR <br />LIMITSA <br />ADDI POLICY EFFECTIVE POLICY EXPIRATIONLTR <br />INSRD TYPE OF INSURANCE EOLICY NUMBER DATE (MMIDDfYY) DATE (MMIDDIYY) <br />NOTICE TO THE CERTIFICATE HOLDER NAMED - E LEFT, BUTFAILURETC, DOSO SHALL <br />X <br />GENERAL LIABILITY <br />.. <br />92 -C9 -V665-7 <br />06/01/17 <br />06/01/18 <br />EACH OCCURRENCE $ 2,000,000COMMERCIAL <br />PRE ISES (Ea occurrence) $ 2,000,000]CLAIMSMADE <br />20 CIVIC CENTER PLZ <br />SANTA ANIL, CA 92701 <br />JOHN LUITHLY <br />GENERAL LIABILITY <br />MED EXP (Any one person) $ 5,000PERSONAL& <br />7X OCCUR <br />ADV INJURY $ 2,000,000GENERAL <br />AGGREGATE $ 4,000,0004,000,000POLICYLIJECT <br />LOC <br />X <br />AUTOMOBILE <br />LIABILITY <br />085 9537-BOI-75J <br />08/01/17 <br />02/01/18* <br />COMBINED SINGLE LIMIT $ $1,000,000(Ea <br />accident)ANY <br />AUTO <br />2014 MERCEDESBODILY <br />ALL OWNED AUTOS <br />WDDLJ7DBSEA100763 <br />INJURY $x <br />(Per person)SCHEDULED <br />AUTOSX <br />HIRED AUTOS <br />BODILY INJURY $(Per accident)X <br />NON -OWNED AUTOSX <br />COMP DED - $500 <br />PROPERTY DAMAGE $(Per <br />accident)IX <br />COLL DED - $500GARAGE <br />LIABILITY <br />AUTO ONLY � EA ACCIDENT $\NY <br />AUTO <br />OTHER THAN EA ACC $* <br />X <br />EXCESS/UMBRELLA LIABILITY <br />7S -CD -2498-7 <br />08/02/17 <br />08/02/18 <br />EACH OCCURRENCE $ 3,000,000OCCUR <br />AGGREGATE $DEDUCTIBLE <br />FICLAIMS MADE <br />$C <br />WORKERS COMPENSATION AND <br />92 -EU -X230-7 <br />09/01/17 <br />— ITORY L'MIQ I DEREMPLOYERS' <br />E.L. EACH ACCIDENT $ 1,000,000ANY <br />LIABILITY <br />PROP RIETOR/PARTNERtEXECUTIVEOFFICERIMEMBER <br />1,000,000If <br />EXCLUDED? <br />EL DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE - POLICY LIMIT . $ 1,000,000SPECIAL <br />Ves, desc"ibe under <br />PROVISIONS belowOTHERDESCRIPTION <br />OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONSCERTIFICATE <br />AND ADDITIONAL INSURED COVERS AGREEMENT #A-2015-155, A-2011-068, A-2016-285REVIEWED <br />BY: EUNICE HE <br />ctm/I-x.//cnvLU=" <br />ADDITIONAL INSURED: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA71ON <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />CITY OF SANTA ANA <br />NOTICE TO THE CERTIFICATE HOLDER NAMED - E LEFT, BUTFAILURETC, DOSO SHALL <br />IMPOSE NO OBLIGATION OR LIABIdT F ANY IND UPON THE INSURER, ITS AGENTS OR <br />ITS OFFICERS, EMPLOYEES AGENTS <br />C/O ROSS ANNEX <br />AUTHORIZED REPRESENTATIVE <br />20 CIVIC CENTER PLZ <br />SANTA ANIL, CA 92701 <br />JOHN LUITHLY <br />xoonoeo /ne�n�'a«»''o"""""�"=""==s"'~^~^^~~^~'`~^`~~~-----1 '1 All —\��� Aiihgms,w��*u <br />�n�* v�`:�v ' , ~ .�� <br />