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<br />%_ %_P1% " DATE. (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY
<br />INSURANCE 10/20/2016
<br />THIS CERTIFICATE 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 COVERAGEAFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
<br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANP. If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 WAIVED, sublectto the terms and
<br />conditions of the policy, certain policies may require an endorsement. Astaternent on this certificate does not confer rights to the certificate holder In lieu starch endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Goias Dolatabadl(295033N)
<br />PHONE
<br />FAX
<br />1451 W 7th St Ste A
<br />(A/C, NO, EXT): 310-371-3575
<br />(A/C, NO): 855320-8748
<br />E-MAIL --- —
<br />San Pedro CA 90732.3524
<br />ADDRESS: gminsuranceservicesl@gmail.com
<br />INSURER(S)AFFORDING COVERAGE NAICS
<br />INSURED
<br />INSURERA: HUSDON SPECIALTY INSURANCE COMPANY 25054
<br />INSURER B:
<br />DULUX PAINTING
<br />--
<br />INSURERC:
<br />INSURER D:
<br />26 ROCKINGHORSE RD
<br />INSURER E:
<br />RCH PALOS VRD CA 90275
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAME ABOVE FOR l"HE POLICY PERIOD INDICATED, NOTWITHSTANDING ANJBYTHE
<br />REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOPOLICIES
<br />DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDTL
<br />INSD
<br />SUBR
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />LIMITS
<br />6OMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />X OCCl1R
<br />DAMAGE TO RENTEDCLAIMS-MADE
<br />PREMISES(Ea Occurrence)
<br />MED EXP(Anyone person)
<br />5,000
<br />PERSONAL &ADV INJURY
<br />$ 2,000,000
<br />HBD 10007003
<br />01/13/2016
<br />01/13/2017
<br />GENT AGGREGATE LIMIT APPLI ES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY lJ PROJECT n LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 4,000,000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABI LITY
<br />COMBINED SINGLE LIM IT
<br />(Eaaccident)
<br />$
<br />BODI LY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />B
<br />OWNEDAUTOS SCHEDULED
<br />ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HI RED AUTOS NON OWNED
<br />ONLY AUTOSONLY
<br />PROPERTY DAMAGE
<br />(Peraccident)
<br />$
<br />UMBRELLALIAB
<br />OCCUR
<br />EACHOCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />:]::DTE_
<br />RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />PEROTHER
<br />STATUTE
<br />$
<br />ANY PROPRIETOR/PARTNER/ Y/N
<br />EXECUTIVE OFFICER/MEMBER
<br />N/A
<br />E.L. EACH ACCIDENT
<br />$
<br />—
<br />E.L. DISEASE- EA EMPLOYEE
<br />EXCLUDED? (Mandatory in NH)
<br />E.I-.DISEASE - POLICY LIMIT
<br />$
<br />Ifyes, describe under DESCRIPTION OF
<br />OPERATIONS below
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached timers space 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 property),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 arise from or any manner related (see the attached )
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />CITY OF SANTA ANA
<br />DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA M-11
<br />AUTHORIZED REPRESENTATIVE GOLSA DOLATABADI 10/20/2016
<br />— SANTA ANA fA_92:
<br />_ ...
<br />ACORD 25(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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