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--�•_1 BLUEMAN-02 F_ GINBODE '4� R� CERTIFICATE OF LIABILITY INSURANCE D 03122/20/ YY) 03122/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 01319762 gONTACT Momentous Insurance Brokerage Inc AME: HONEFAX 5990 Sepulveda Blvd., #550 - (A/C, No, E,n): (818) 933-2700 - (AIC, No):(818) 933.2701 Van Nuys, CA 91411 ADDRESS: INSURER(S) AFFORDING COVERAGE - HAIG9 INSURERA: Philadelphia Indemnity Insurance Company _18058 INSURED ' ` 1 p ._rV^V L _ INSURER e: Sentinel Insurance Company_ 11000 Blueray Management LLC ry _ INSURERC: P.O. Box 12529 INSURER D: Newport Beach, CA 92658 INSURERS: NNSURERF: COVERAr.FR CFRTICICATP MI I11tlOCo• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR� TYPEOFINSURANCIS AD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIALGENERALLIABILITY - - 2,000.000 EACH OCCURRENCE S _ CLAIMS -MADE X OCCUR X PHPK1794789 0312412018 0312412019. DAMAGE NTTiRenca) 100,000 $ - - MEDEXP(Anyoneperspn) $ 0 - - PERSONAL$ AOV INJURY $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 4.000.000 POLICY PRO- JECT - - LOC PRODUCTS - COMP/OP AGO S 4,000,000 OTHER' $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMB 11000,000 $ X ANYAUTO PHPK1794789 0312412018 0312412019 - BODILY INJURY (Per person).,5 OWNED SCHEDULED X .AUTOS ONLY .BODILY AUTOOSy�N INJURY (Per amdenl) 3 X AUTOS AUTOS PROPERTY DAMAGE ONLY ONLY den_3 UMBRELLA OAS OCCUR EACH OCCURRENCE S excess UAB CLAIMS -MACE .AGGREGATE $ .DED RETENTION$ WORKERS COMPENSATION -PER.0TH• AND EMPLOYERS LIAMUTY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE -- - FFICERIMVE9g9E), EXCLUDEDT NIA antlaloryin NH) E.L. EACHACCIDENT S - De u nder rRIPTION E. L. DISEASE - EA EMPLOYEE S dRIPOl OF OPERATION$ emew - EL DISEASE •POLICY LIMIT S B Business Owners Poli 72SBAAR9861 0311512018. 0311612019 BPP 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may M almehed if mere space is required) , G�evas0, City of Santa Ana Don Stocker 20 Civic Center Plan Santa Ana, CA 927014058 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. , AUTTHHORUED REPRESENTATIVE ' U ^--^-- �- 1-•• •-•-�, W 1688-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD