RIVER VIEW GOLF, LLC; FKA: KEANE, MARY (RIVER VIEW GOLF COMPANY)

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AG'C�FbP CERTIFICATE ®F LIABILITY INSURANCE h,...�-"' DATE /2018) 11/zo/zole THIS CERTIFICATE IS ISSUED ASA 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 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 Wigmore Insurance Agency Inc.PHONE 880 W. 19th St. License 40811959 Costa Mesa CA 92627 NAME; W -9-0-e Insurance (714)979-6543 pIC No: 19341 sac -alas ik-.%.-'.Lo�rcial@wignoreins.com commercial@wignoreins.com INSURERS AFFORDING COVERAGE NAIC Al INSURERA:West American Insurance Co. 44393 INSURED River View Golf, LLC 1800 W 22nd St Santa Ana CA 92706 INSURER B: Ohio Security Insurance Co. 24082 INSURER C: American Fire and Casualty Co. 24066 INSURER D: Employers Assurance Company25402 INSURERE: 1 INSURERF: COVERAGES CERTIFICATE NUMBER:2018 Renewal REVISION NUMBER: 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 CONTRACT OR 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF MMIDDry Y POLICY EXP M IDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE $ 1,000,000 PREMIDAMASES 500,000 PREMISES Ea ccurtance $ (E' =u MED EXP (Any one arson) $ 5,000 X 30156843025 8/1/2018 8/1/2019 PERSONAL &ADV INJURY $ 1,000,000 GENTAGGREGATE LIMITAPPLIES PER: X POLICY ❑ JECTPRO- F-1 LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS COMPIOPAGG $ 2,000,000. lmor Llablluy $ 1,000,000 OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acd ant BODILY INJURY (Per person) $ EANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BA856043825 8/1/2018 8/1/2019 BODILY INJURY(Peraccidsnp $ X HIREDAUTOS X AUUTOS ED (PRO er ac TY ldent) MAGE $ $ X I UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 31000,000 AGGREGATE $ 31 000. 000 C EXCESS LIAB CI -AIMS -MADE DED X RETENTION $ 10,000 $ USA56943825 0/1/2018 8/1/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN APE OR STATUTE E.L. EACH ACCIDENT $ 11000,000 D ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA EIG227064103 10/1/2010 10/1/2019 E.L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, doscdbe antler E.L. DISEASE -POLICY LIMIT $ 1,000 000 DESCRIPTION OFOPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more apace is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED PER COMMERCIAL GENERAL LIABILITY EXTENSION FORM CG88100413. a �y. -as CERTIFICATE HOLDER CANCELLATION ... "n SHOULD ANY OF THE ABOVE DESCRIBEI.P%tCi1WS' BE`CANCELLI The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Silvia Cuevas ACCORDANCE WITH THE POLICY PROVISIONS. PRCSA M-23 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 Timothy Wigmore/K190 ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)