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10639. /.Jon on Me, Inc.
<br />Certificate of Insurance _"— `'(page of 1) 10/22/2015 10:46:03 AM
<br />ACC> xia� CERTIFICATE OF LIABILITY INSURANCE
<br />iI,i,,,,,,..�-'
<br />010/22/2015""'
<br />1012'2/2015
<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 PRODU,,R/°AND ry6f�'f CL J T( IAAJ HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain poli4ies may. require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of s 'B - o j
<br />PRODUCER[':, 'I'�
<br />C l 1 I rr { I
<br />CONTACT
<br />NAME:
<br />SelectSolutions Insurance Services, LLC #0127711
<br />1350 Carlback Avenue
<br />Walnut Creek, CA 94596
<br />PHONED Ext. 866-500-6359 AX (AIDNo: (855) 804-II449
<br />E-MAIL
<br />ADDRESS,
<br />PRODUCER
<br />CUSTOMER
<br />INSURERS AFFORDING COVERAGE
<br />NAICA
<br />INSURED
<br />INSURERA: Scottsdale Insurance Company
<br />41297
<br />INSURER B: Hartford Fire Insurance Company
<br />19682
<br />Lien on Me, Inc.
<br />P.O. Box 91630
<br />Pasadena, CA 91109 -
<br />INSURER C: Sentinel Insurance Company, Limited
<br />11000
<br />INSURER D
<br />INSURER E:
<br />DAMAGE 10 RE TEDPREMISES JEe occurrence $ 1,000,000
<br />MED EXP (Any one person) $ 10,000
<br />INSURER F:
<br />CLAIMS -MADE S OCCUR
<br />COVERAGES CERTIFICATE NUMBER: RFTnRIEN w IMRFR-
<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 />HER
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDl1'1'Y1'
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 11000000
<br />I/COMMERCIAL GENERAL LIABILITY
<br />DAMAGE 10 RE TEDPREMISES JEe occurrence $ 1,000,000
<br />MED EXP (Any one person) $ 10,000
<br />CLAIMS -MADE S OCCUR
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />C
<br />Yes
<br />72-SBAAG7645DX
<br />8/1512015
<br />8/15/2016
<br />_
<br />GENERAL AGGREGATE $ 2,000,000
<br />_OFN'L AGGREGATE
<br />LIMIT APPLIES PER,
<br />_PRODUCTS-COMP/OP AGG $ 2,000,000
<br />✓ POLICY
<br />PRO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />E. accitlenp $ 1,000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />C
<br />—
<br />✓
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />Ves
<br />72-SBAAG7645DX
<br />8/15/2015
<br />8/16/2016
<br />PROPERTY DAMAGE $
<br />(Per accident)
<br />✓
<br />NONOWNEDAUTOS
<br />$
<br />$
<br />✓
<br />UMBRELLA UAB
<br />✓
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />—
<br />Yes
<br />]2-SBAAG7645DX
<br />8115/2015
<br />6/15/2016
<br />_
<br />DEDUCTIBLE
<br />- —
<br />$
<br />$
<br />✓
<br />RETENTION $ 10,000
<br />WORKERS COMPENSATION
<br />WCSTATII- OTH-
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUI IVE
<br />OFFICEGMEMBER EXCLUDED4
<br />NIA
<br />E.L EACH ACCIDENT $
<br />E.LE.L. DISEASE 1A EMPLOYEE $
<br />(Mandatory in quit
<br />If yyes, describe under
<br />---
<br />E.L, DISEASE -POLICY No$
<br />DESCRIPTIONOFOPERATIONS below
<br />A
<br />Professional Llebtity(Ease and Omlociare)
<br />EK83162804
<br />3/25/2016
<br />3/25/2016
<br />$1,000,000/$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additions Remarks Schedule, if more space is required)
<br />ertificate Holder is named as Additional Insured as their interests may appear in regards to General Liability
<br />B: BOND 72BDDDF9643 1/28/2014 - 1/28/2017 $130,000
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2009/09)
<br />1988-2009 The ACORD name and logo are registered marks of ACORD RD CORPORATE. ,p�lt`iuh}sir d��1,K
<br />���0���4yY//, �j`V - ,I,f/nlU„� �C,
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE
<br />WILL BE DELIVERED IN
<br />20 Civic Center Plaza (ni
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2009/09)
<br />1988-2009 The ACORD name and logo are registered marks of ACORD RD CORPORATE. ,p�lt`iuh}sir d��1,K
<br />���0���4yY//, �j`V - ,I,f/nlU„� �C,
<br />
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