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ACORH
<br />L� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />1 9/16/2024
<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: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) 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
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Frances Nobles
<br />Chrysalis InsuranceA Agency (Incorporated)
<br />hrY g Y ( tp )
<br />PHGNE 714 464-8080 ) (714)464-8070
<br />AIC, No, Ext . ( ) (pIC, No
<br />ADDRESS: s,,ice@ciapro.net
<br />3001 Red Hill Ave, Ste. 2-226
<br />INSURER(S) AFFORDING COVERAGE
<br />NAILIf
<br />INSURER A: ADMIRAL INS CO
<br />24856
<br />Costa Mesa CA 92626
<br />INSURED
<br />INSURER B: AMGUARD INS CO
<br />42390
<br />INSURER C : MIDWEST EMPLOYERS CAS CO
<br />23612
<br />Sunny Hills Associates Inc. d/b/a SUNNY HILLS RESTORATION
<br />INSURER D: OHIO SECURITY INS CO
<br />24082
<br />1999 RITCHEY ST
<br />INSURER E:
<br />INSURERF:
<br />SANTA ANA CA 92705-5100
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />LTR
<br />TYPE OF INSURANCE
<br />INSO
<br />WVD
<br />POLICY NUMBER
<br />(MMIDDIYYYY)
<br />(MM/DDNYYY)
<br />LIMITS
<br />A
<br />x
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />POLLUTION LIABILITY
<br />Y
<br />Y
<br />FEI-ECC-35209-02
<br />05/15/2024
<br />05/15/2025
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES (Ea occurrence)
<br />8 100,000
<br />x
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />PROFESSIONAL LIABILITY
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />x
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY �JECT LOG
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMPIOP AGO
<br />$ 2,000,000
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED V SCHEDAUTOAUTOS ONLY F)SULED
<br />�
<br />HIRED V NON-0WNED
<br />ONLY /� AUTOS ONLY
<br />Y
<br />Y
<br />SUAU458901
<br />04/10/2024
<br />04/10/2025
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />V
<br />FKUHLRAUTOS
<br />(Peraccidenq
<br />$
<br />A
<br />UMBRELLA UAB
<br />EXCESS LIAB
<br />x
<br />OCCUR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />FEI-EXS-45093-02
<br />05/15/2024
<br />05/15/2025
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />K
<br />AGGREGATE
<br />$ L000,000
<br />DED RETENTION$
<br />PRODUCTS/COMPLETI
<br />S 1,000,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YINANY
<br />OFFICER/MEMBER EXCLUDEDXECUTIVE�
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />NIA
<br />Y
<br />BNUWC0161368
<br />11/14/2023
<br />11/14/2024
<br />/� STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />Commercial Property & Inland Marine
<br />BKS61278353
<br />4/7/2024
<br />4/7/2025
<br />Misc Equipment
<br />Property of Others
<br />Systems Breakdown
<br />$55,000
<br />$302,575
<br />$302,575
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aftached If more space Is required)
<br />See ACORD 101
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />'k
<br />rtmm,d,as•m=et
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />by.
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
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<br />amnam amyner.a.=a nr;
<br />aa, r. r1_11 the
<br />AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />— Pisk Ma.uyv,
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />`/� _
<br />9)1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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