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AC R CERTIFICATE OF LIABILITY INSURANCE <br />D.1IE {_Aa!�I:DD:YYYYI <br />13/26/2018 <br />THIS CERTIFICATEIS 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(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such Nand.»cn.nn..*t.t <br />BIN INSURANCE HOLDINGS LLC/PHS <br />505500 P: (866) 467-8730 F: (888) <br />PO BOX 33015 <br />SAN ANTONIO TX 78265 <br />INSURED <br />HJELMSTROM&ASSOCIATES <br />25072 WILES PL <br />LAGUNA HILLS CA 92653 <br />COVERAGES <br />(Ar,N--* (866) 467-8730 <br />443-61121 Ao RESS. <br />Naz (888) 443-6112 <br />INSURERS) AFfORD1NG COVERAGE NAIDy <br />INSURERA:Septi Al Ins Co LTD <br />INSURER B: <br />INSURER C <br />INSURER D: <br />INSURER E. <br />INSURER F <br />------...._..� ._.,....,�... <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTREVISION NUMBER: <br />ED 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 WITH RESPECT TO WHICH THIS THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />CERTIFICATE MAY BE ISSUED OR MAY PERTATHE INSURANCE AFFORDED B <br />IN, <br />TERMS,EXCLUSIONSAN0 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />Lrsr( 7PPE0FLVSrJz&- (E !DD Svi ructcs'erF <br />rOL!('1'.N(.3fCL'6 <br />/driflDD/i71' 14fY75 <br />A <br />COMMERCIAL GENERAL LIABILnY <br />CLAIMS MADE FRIOCCUR <br />% General Liab <br />46 SSM UV13901 <br />04/16/2^i1B <br />04!-'6/2C19 /2Gi., <br />EACH OCCURRENCE 1, 000, 000 <br />DAILIAGE TO RENTED PREMISES ,1 O O O 000 OO <br />Ea occurrence). i <br />X <br />MED EXP (Any one person) X107 000 <br />PERSONAL & ADV INJURY - 0 <br />, 000 r 0 0 0 <br />GEN'LAGGREGATELIMIT APPP-1 L�IESPER <br />POLICY FI JECaT- I ){ I LOC <br />L -- <br />OTHER: <br />GENERAL AGGREGATE ;2,000,000 <br />PRODUCTS - COMPiOP AGO g2 7 Q 0 Q r 0 0 0 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />BODILY INJURY (Per person) ; <br />_ <br />BODILY INJURY (Por accident) .S <br />PROPERTY DAMAGE <br />(Per accident) <br />UMBRELLA LIAB <br />EXCESS LLAB [4CLAIMS-IMMADE <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />SORLFlfsC7Wl'�'V&9Tf0\ <br />REFFNi1pN 5 <br />�'VDLfItloFEJ1S-f.L9EFL7F <br />ANY PROPRIMB R ExCLuoED? CUTIVD(fN <br />OFFICERfM14EMBEREXCLUDEp7 ❑ <br />(fdandatory in NH).. <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />xiA <br />PER OiH-- <br />SFAME ER <br />E L. EACH ACCIDENT <br />E.L. DISEASE EA EMPLOYEE ' <br />E.L. DISEASE -POLICY LIMIT <br />DEE SCRlP'n0N OFOPERATMS /LOCATIONS / VEHICp=RD i01, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. Please see Additional Remarks <br />Schedule Acord Form 101 attached_ <br />REVIEWED BY: EUNICE HEREDIA (PG OF <br />CFRT1l=IreT1= ►ani 111c0 <br />(City of Santa Ana <br />Attn: Purchasing Department <br />20 CIVIC CENTER PLZ <br />SANTA ANA, CA 92701 <br />ACORD 25 (2016/031 <br />Tho Amon ._.. _-1 r <br />.+..--Vtr <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS <br />v 19UU-2015 ACORD <br />-•-•--- -"- w e ■cyamc.ou 1114umS Or AVUKU <br />UL <br />ed. <br />