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Last modified
4/19/2024 10:20:10 AM
Creation date
4/19/2024 10:09:22 AM
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Contracts
Company Name
LAM, EMMY
Contract #
N-2024-136
Agency
Library
Expiration Date
5/22/2024
Insurance Exp Date
5/17/2024
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A`"Rly CERTIFICATE OF LIABILITY INSURANCE °" (W" M" NY <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: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terns 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($). j,y�p�q �y PROVeracity DUCER Insurance Solutio ,LLC. Di v 4yP'�47r6 31H °Angie.. - _ - <br />V �/-�! IggA__c,,,,,N�P�,,I1 u. C Ipac.IgX (801}763.1374 <br />ea,gic``SI-A ce W e�d O AC <br />1Y ICCi� infoQauinsurance_com <br />��✓JJINSURER(SI AFFORDING COVERAGE <br />Da Ie02ii4:A'fk�y001_ 26832 <br />-- R <br />INSURED INSURER a: — <br />EmmY Lam INstmEac: —� <br />1465 Tamarind Ave. #565 INSURER D: <br />Los Angeles CA 90D28 wsuaFx E: <br />INSURER F: <br />rrnVRRAGFR CPRTIPWATP MIIMRGR• RCVIRVYM MIIMRFR• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />MaR T L`$URY iFC I EFF POLICY FXP <br />� <br />L TYPE OF INSURANCE i POLR:YNUMSER LaaTS <br />GENERAL LIABILITY <br />EACH OCCURRENCE S 1.0DO.000 <br />X COAWERCIAL GENERAL /MIBRITY <br />GENE <br />j � <br />'.1�"" <br />f OAMAGETORENIEO �0D0 <br />r PREMISES lEs ocanremR) S <br />CERCM <br />X OCCUR <br />I <br />I <br />4 MED EXP (Ate r P t S 5,000 <br />A <br />_ _ <br />� PLE957546-AS286141 <br />OS115l2024 � 0511712024 <br />�ttII <br />, � _ <br />PPx9oNa anov lwuav s EXCLUDED <br />dENERAL AGGREGATE S 2,000,000 <br />ORNL AGGREGATE LART APPLIES PER. <br />If PRODUCTS. COMPOP AGG S EXCLUDED_ <br />X POLICY L P Loc <br />I ANIMAL BAILEE 3 <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />SOD0.Y INJURY (Pr pi~) S <br />ALL OWNED SCHEDULED <br />AUTOS �1AUTOS <br />j <br />BODAY I <br />INJURY IWr AEU S <br />NONED <br />PROPERTY DATUCE f <br />VIREO AUTO f_ AUTOS <br />Ift APaNpI. <br />OCCUR <br />r <br />i-1 <br />EACH OCCURRENCE S <br />OLCESS M'}M C_ WMBAWSE_ <br />AGGREGATE. S <br />IRElENT10N1 <br />S <br />WORKERS OOMPEMTION <br />WCSTATV '� .OTH <br />AIO9PLOYERO'LIABILnT YIN <br />TORY LIMBS, ER, <br />ANY PROMiiETORMARTNEREXECURvE <br />NIM,II <br />r <br />EL EACH ACCIDENT S <br />O"KAMIEMSEREXCLUDEDt <br />pWn4Mry M m) <br />'II E L DISEASE - EA EMPLOYEE S <br />e MI.WUb uMN <br />' <br />E L DISEASE - PULH:Y uMrt { <br />FF <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVENKLES IRRxAACORDT01,A40ISNNMR~BSCIIa4.RMMSpR NIe""OI <br />Certificate holder has been added as additional insured regarding the above mentioned polky per attached <br />Additional Insured - Designated Person or Organization (CG20 26, ED. 04 13) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City, Its City Council, Its officers, officials, employees, agents and THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Volunteers ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />4D1988.2014 ACORD CC <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />INS0251mL01I <br />.v1"_v.,�c <br />RMrMMssBLmMntDMlbn <br />REVIEWID&APPROVED BY: <br />MOWER <br />Rhk Management Speargist <br />
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