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<br />W....-- CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />1_0/20/2016
<br />_
<br />THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY
<br />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),
<br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and
<br />conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />NAME:
<br />GDisa Dolatabadi(295033N)
<br />PHONEFAX
<br />COMMERCIAL GENERAL LIABILITY
<br />1451 W7th St SteA
<br />(A/C, NO, EXT): 310-371-3575
<br />(A/c, NO): 855-320-8748
<br />— _
<br />E-MAIL
<br />ADDRESS: gminsuranceser0cesl@gmail.com
<br />San Pedro CA 90732-3524
<br />–
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIL#
<br />INSURED
<br />INSURER A: HUSDON SPECIALTY INSURANCE COMPANY
<br />25054
<br />INSURER B:
<br />DULUX PAINTING
<br />INSURERC:
<br />—
<br />INSURER D:—
<br />$ 5,000
<br />26 ROCKINGHORSE RD
<br />INSURER E:
<br />RCH PALOS VRD CA 90275
<br />INSURER F;
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS ISTO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
<br />REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE
<br />POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLIHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OFINSURANCE
<br />ADDTL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE X OCCUR
<br />DAMAGETORENTED
<br />PREMISES (Ea Occurrence)
<br />$ 100,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />PERSONAL&ADV WJURY
<br />$ 2,000,000
<br />HBD 10007003
<br />01/13/2016
<br />01/13/2017
<br />'GEN'L AGGREGATE LIM IT APPLI ES PER:
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />POLICY ❑ PROJECT a LOC
<br />PRODUCTS-COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />ANVAUTO
<br />BODILY INJURY (Per accident)
<br />$
<br />B
<br />OWNEDAUTOS SCHEDULED
<br />ONLY AUTOS
<br />HIREDAUTOS NON -OWNED
<br />ONLY AUTOSONLY
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />UMBRELLALIAS
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />PER
<br />5'fATU'fE
<br />OTHER
<br />$
<br />E.L. EACH ACCIDENT
<br />$
<br />ANY PROPRIETOR/PARTNER/ Y/N
<br />EXECUTIVE OFFICER/MEMBER
<br />EXC LUDED7 (Mandatory In NH)
<br />Kyes, describe under DESCRIPTION OF
<br />OPERATIONS below
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE .
<br />E. L. DISEASE - POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONSAOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if morespace Is required)
<br />to the fullest ectent permitted by law, contractor shall indemnity, defend and hold harmless City, its officers, agents and employees( collectively, the indemnified
<br />parties)from and against any and all claims (including, without limitation, claims for bodily injury, death or damage to properly),demands, obligations, damages,
<br />actions, causes of action, suits, losses, judgments, fines,penalties, liabilities, costs and expenses( including, without limitation, attorney's fees,disbursements and
<br />court costs) of every kind and nature what so ever(individually, a claim; collectively, "claims")which may SLIER from or any manner related (see the attached )
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />CITY OF SANTA ANA DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA M-11 AUTHORIZED REPRESENTATIVE GOLSA DOLATABADI 10/20/2016
<br />SANTA AMA C U
<br />ACORD25(2016/03)
<br />31-1769 11-15
<br />©1988-2015 ACORD CORPORATION. All Rights Reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />
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