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_ CERTIFICATE OF LIABILITY INSURANCE9A04252(}17YYY) <br />HrS TCERTIFICATE IS ISSUEDASAMATTERpF INFORMATION ONLY AND CONF&RS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES No TAFFIRMA71YELYOR NCGATIVMY <br />AMEN D. EXTENV OR ALTERTHECOVENAGEAFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CbNSTITUTEA CONTRACT ItETW EEN TIME 1S5UING INSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: III cortifitato holder Is an ADDITIONAL INSURED, the peiicy(les) must have ADDITIONAL INSURED provlslo rla or ye endorsed, If SUBROGATION 15 WAIVED, subject to thaterma and <br />conditions of the policy, rcrtalnpollcles may require an endorsement. A statement on *Is cardRcatedoes not confor eights to the cartlRcatollaldCY In Mau of such andcrsermot(s), <br />PRODUCER <br />CONTACT <br />NAMEr QUYEN HOANG <br />PARKSIDE IWURANCrE SE RVICES, INC <br />18911 l3rookhUrat 5t <br />PHONE <br />(A/C, NO, EXT); 714-705.9453 <br />FAX <br />(A/c, Nolt 714-939-7301 <br />EMAIL <br />ABDRESS; PARK8(0EINS0GMAIL,COM <br />Fountain Valley CA 9770E <br />INSURIER(S)AFFORDiNGCOVERAGC <br />NAICd <br />INSGRHD W� <br />INSURItiRA: EMPLOYERS PREFERREC INSURANCE CO <br />' <br />ELIZALIDE, GUILLERMO <br />DII SUPER ANTOJ ITOS EXPRESS <br />INSURER <br />R ElkE <br />INSURER D; <br />1702 N BRISTOL ST STE 0 <br />INSURER E; <br />SANTA ANA CA 92708 <br />IN5URERF! <br />CUVHRAGES CERTIFICATFNUMII REVISION NUMBER; <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFABOVE FOR THE POLICY PERICO )NDICATED. N 07WIT44STANOINO ANY <br />REQUIREMENT, TERM OR CONDITION OFANYCDNTRACTOR OTHER DOCUMENTWITH RESPECT TOWN ICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE IN5URANCEAFFORDED BYTHR <br />POLICIES DESCRIBED HEREIN IS SUSJECTTO ALLTHE TERMS, EXCLUSIONSAN1) CONDITIONS OF$UCH PCI.ICII LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYp$OFIN5URANCB <br />ADDTL <br />INSD <br />SUER <br />WVO <br />POLICY NUMBER <br />POLICYEFF <br />(MM/bD/YYYY) <br />POLICYRXri <br />(MM/DD/YYYY) <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACHOCCURRENC€ <br />$ <br />CLAIMS -MARE OCCUR <br />DAMAGETORENTEDPRCMISE$(FaOccurrence) <br />$ <br />MEUEXP(Anynneperson) <br />$ <br />PERSONAL& ADV INJURY <br />$ <br />GEN'I.AGGREGATE L€MITAPPLIESPER: <br />GENERALAGGREGATIE <br />It <br />POLICY ❑ PROxcT ❑ WC <br />PRODUCTS .COMPMPACGG <br />$ <br />OTHER; <br />5 <br />AUTOMOBILP LIABILITY <br />ANYAUTO <br />�° <br />COMBINED SINGLE LIMIT <br />(Eaaccident) <br />$ <br />_ <br />B00110fINJURY (Perperson) <br />$ <br />OWNEDAUTO5 SCHEDULED <br />ONLY AUTOS <br />HIRED AUTOS NON -OWNED' <br />ONLY AUTOS ONLY <br />p <br />a <br />BODILY INJURY (Per accident)$ <br />PROPERTY DAMAGE� <br />(Pwaccideot) <br />$ <br />, <br />$ <br />UMBRkI-LALIAB <br />OCCUR <br />1 <br />EACHOCCURIIENCE <br />$ <br />EXCE55LIAa <br />CiAIM5-MADE! <br />! <br />AGGREGATE <br />$ <br />DEp RErEN[ION$� <br />S <br />WORKERSCOMPENSATSON <br />AND EMPLOYERS' LIABILITY <br />�STATUTE <br />PLR <br />nTIMCRM <br />$ <br />A <br />ANY PROPRIETOR/PARTNER/ Y/N <br />FXKVTIVEOFFICER/MEMBER Y <br />EXCLUDED? (Mundaturyin NH) <br />N/A <br />EIG224134900 <br />11101/2018 <br />11/0112017 <br />E.L,EACHACCIDENT <br />$ 1.000,000 <br />ELpISEA3H-EAEvIPLOYEC 1,000,000 <br />ifyea,describe under DESUMPTIONOF <br />OPERATIONS below <br />E.LDISEA5E-POLICY LIMIT' <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If nlnrespacC is required) <br />Certlfioate holdar, its officers, agents, and employees are named as Additional Insured, Should any of the above described policies ba Cancelled before the <br />expiration date thereof, the Issuing insurer wlll endeavor to mall 30 days written notlas to the Edditlonal interest named below, but failure to mall such notice <br />shall Impose no obligation or Ilabllity of any kind upon the Insurer, Its agents or representatives, <br />1p- days nctice of cancellation Tor nonpayment <br />CERTIFICATE HOLDER CANCELLAMCN <br />.. City of5antaAna SHOULDANYOFTHEABOVEDESCRIBED POUCIESBECANCELLEDBEFORE THEIEXPIRATION <br />Attn: r-PCSA DATE THEREOF,NOTICE WILL BE DELIVERED INACCORDANCEWITHTHE POLICY PROVISIONS, <br />20 Civic Conter Plaza M-23 <br />[ -- - Santa Any <br />ACORIO 25 (2016/03) (�) 1988-2015 ACORD CORPORATION. All Rights Rotarved <br />31.1769 11-15The ACORD name and logo aria reglsteredmarks ofACORD <br />