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<br />ACi;Ze CERTIFICATE OF LIABILITY INSU.
<br />ISSUEDTHIS CERTIFICATE IS OF]INFORMATION M w CONFERS .
<br />0
<br />AFFIRMATIVELY. THIS
<br />CERTIFICATE DOES NOT w EXTEND OR ALTER THE COVERAGEAFFORDED BY •
<br />BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING INSURER(S), „ E r
<br />REPRESENTATIVE R PRODUCER, , THE, CERTIFICATE HOLDER,
<br />IMP011 If the Certificate holder Is an ADDITIONAL INSURED, the policyi must If SUBROGATION IS WAIVED, subjeict to
<br />thie terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights tothe
<br />certificate holder In lieu of
<br />�-RODUCER EdCONTACT
<br />w
<br />1,aewood Partners,
<br />nce Center (EPIC�) NAMI
<br />00 MacArthur Blvd. PH Roor PHON I FAX
<br />a •e. a 4 ♦ II
<br />Irvine, CA 92612
<br />COVERAGES CERTIFICATE NUM ER: 27371474 REVISION! NUMBER:
<br />THIS IS TO CERTIFY THAT THE (POLICIES OF INSURANCE LISTEDBELOW 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 lN1TH 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 />VSR - A.DDL SUBR (POLICY EFF j POLICY EXP LIM9TS
<br />„TR TYPE OF INSURANCE POLICY NUMBER MMdDD/YYYY MMIDDdYYYY
<br />A Y/ COMMIERCIALGENERALLVABIUTY PHP
<br />1423915 11/2212015 1 11/2212016 PREMISES
<br />EACHaccUI�rzENcE 1,000,000
<br />CLAIMS -MADE OCCUR GIE R � E LNTEO — –
<br />L.�.....I RHMISDS Eap cmrrene ] . 1,000,000
<br />.. BI1PD Ded 5 CQLI MED EXP (Any one person) $ 20,000
<br />!
<br />PERSORAL ADV INJURY
<br />GENERAL AGGREGATE
<br />$ 1,000,000
<br />$ 2,000,000
<br />GENT AGGREGATIE LIMIT APPLIES PER:
<br />POLICY E PRCJ-
<br />JEGT ®LCiG
<br />PRODUCTS—)C 7MlPC7PAGC
<br />$ 2,000,000
<br />OTHER: E&O Ded:S 000
<br />Errors and Omissions
<br />$ 1,000,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />PHPK1423913
<br />1112212015
<br />11/22/2016
<br />C.a MnEc�INidEeDmtl 1N ,
<br />$
<br />1E 000,000,
<br />00 000...
<br />ANY UTC
<br />Liability D5,000
<br />BODILY INJURY tPer zers
<br />,
<br />A
<br />ALL OWNED SCHEDULED
<br />PHPK1423921
<br />1112212115
<br />11/2212016
<br />BODILY INJURY 1Per accident)
<br />$AUTOS
<br />AUTOS
<br />NON -C WNED
<br />r✓ HIREDAUTCIS _ AUTOS
<br />is
<br />A
<br />r UMBRELLA LIAB _ OCCUR
<br />._...m.
<br />PHUB522517
<br />11022/2015
<br />11122/2016
<br />EACH OCCURRENCE
<br />.. _ ..
<br />s S,OOO,O7t7
<br />EXCESS LIAR CLAIMS -MADE'
<br />AGGREGATE
<br />� $ 5,000,000
<br />._,_.,....._.... ......_.. ._........___.
<br />.. I7E) RETE ,NTII'ON $ 10,000
<br />__ ....... ........_.. .._ ....
<br />_ ...... ...-._---
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />HC2JUB4252850A15
<br />2112/2015
<br />2/12/2016
<br />✓_. STATUTE.
<br />AND EMPLOYERS' LIABILITY YIN
<br />ERLI-
<br />.._.....
<br />R1EXCLUDEEXECUTIVE
<br />$ 1,000 ,000
<br />OFFICER// MBIEANY
<br />(Mandtory
<br />E.L.DISEASENT
<br />EMPLOYEE
<br />S 1,000,000
<br />f yyes, describe Under
<br />DESC RIPTVON' OF OPERATIONS bellow
<br />_
<br />E DISEASE - PC ICY LIMY r
<br />$ 1,000,000
<br />C
<br />Excess LiabiBity
<br />6020813716
<br />11/22/2015
<br />11122/2016
<br />1,000,000 each occurrence
<br />1,000,000 each aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Rennarks Schedule.,, may he attached'. IF more space is requ Ired)
<br />Certificate Holder is named Additional Insured as respects to General Liabiflty, as required by written contract, per attached form.
<br />rr-'
<br />774-
<br />.FPTIF1'l I"Id`SI nFR rARIt":FI II ATIti :'"'.,` e t'" I
<br />Of Santa n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City
<br />THE EXPIRATION DATE THEREOF„ NOTICE WILL BE DELIVERED IN
<br />Attn: Treasuw Division, M-14 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PO Box 196
<br />20 Civic Center Plaza
<br />Santa Dana A 9270,2 AUTHORIZED REPRESENTATIVE �?
<br />James Johnson
<br />1988-2014 ACORD CORPORATION. Ali (rights reserved,
<br />ACORD 25 (2014101) The ACORD name and Iloagoy are registered marks of ACORD
<br />273U474 1 15-,1,6 area � ,�_ �. WC m stet Ce tif:i,crate I Stephan:i.e N.ico1e:i, 1 11/20/2015 12:'552 PM (P.97) I P.me I of 11
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