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ACC)R <br />"a CERTIFICATE OF LIABILITY INSURANCE ���T6/2/201J6YYY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER, THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER„ AND THE CERTIFICATE, HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such, endorsement(s). <br />PRODUCER <br />UUNIACI <br />NAME: Paul Romero <br />Paul Romero Insurance Agency <br />PHONE No Ext : 805 582 4655 IArc, No): '805-581-3423 <br />2869 Wanda Ave <br />ADDRESS: romeroins@aol.com <br />INSURERIS) AFFORDING COVERAGE <br />NAIC # <br />Simi Valley CA 93065 <br />INSURER A; COLONY INSURANCE CO <br />INSURED <br />INSURER B : MERCURY CASUALTY <br />38342 <br />MAJOR LEAGUE INFIELD INC. <br />INSURERC: REPUBLIC UNDERWRITERS INSURANCE CO <br />508 E Chapman Ave <br />A-2017 p07 <br />r"- R <br />INSURER D : <br />INSURER E <br />,� <br />Fullerton W." CA 92832-2015 <br />INSURERI. <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />VWD <br />POLICY NUMBER <br />(MMIDDNYYY) <br />{MMIDDIYYYY) <br />'...... LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE.. g ± CCCUR.. <br />EACH OCCURRENCE <br />$ 1,000,000 <br />Ea occurrence) <br />PREMISES (,.U.1 <br />$ 100,000 <br />MFD EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />A <br />101 GL0023266-02 <br />07/01115 <br />07/01 /17 <br />GM <br />EN'LAGGREGATE LIMIT APPLIES PER: � <br />POLICY � PRO- <br />JECT LOC <br />GENERAL AGGREGATE <br />S 2,000,000', <br />PROOUOTS-COMPlOPAGG <br />S INCLUDED <br />S <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />(E..a accment) " <br />$ 1,000,000 <br />*yr <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL NED AUTOS AUTOSIWN © <br />HIRED AUTOS �,% Auras <br />13A040000019812� <br />01/0 <br />� 2/2016 <br />O1/02/2017 <br />BODILY INJURY (Peraecldent) <br />S <br />MAGE <br />(Per accidenll <br />S <br />$ <br />UMBRELLA LIAER�,CCIMS-IADI <br />EXCESS LIAR <br />UR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />C%'yl, <br />.�^ <br />' <br />DIED RETENTIONS <br />$ <br />C <br />ORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />FFICER/MEMBER EXCLUDED? ❑ <br />Man, describe <br />be LindNH) <br />If yes, describe under DESCRIPTION OF OPERATIONS below <br />N 1 A <br />y <br />., y" r.+ <br />"`i <br />�'' r <br />ATW008812-0 f�"" <br />'9 \r1 <br />(` <br />01/0112016 <br />01/01/2017 <br />1 STATUTE ER <br />E.L.EACH ACCIDENT <br />$ 1 ,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,1I00,000 <br />E.L. DISEASE .. POLICY LIMIT <br />S 1,000„000 <br />DESCRIPTION.. OF OPERATIONS J LOCATIONS I VEHICLES (ACORD 101„ Additional Remarks Schedule„ may be attached if more space Is required) <br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS RESPECTS TO THE OPERATIONS OF THE NAMED <br />INSURED. WITH RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS PERFORMED BY OR ON BEHALF OF THE. <br />NAMED INSURED, SUCH INSURANCE AS IS AFFORDED BY THIS POLICY IS PRIMARY AND NOT ADDITIONAL TO OR <br />CONTRIiBUTING WITH ANY OTHER INSURANCE CARRIED BY OR FOR THE BENEFIT OF THE ADDITIONAL INSURED. <br />10 DAY NOTICE FOR NON PAYMENT OF PREMIUM. <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE: WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATH AUTHORIZED REPRESENTATIVE <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />pa-tRo-wLt't-0 <br />1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />