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16639 ��L^^^iien On Me, Inc.. Certificate of Insurance (page 1 of 1) 07/08/2016 (}4:44:32 PM
<br />DATE (MMiDDIY'YY'Y1
<br />/��
<br />C" (CERTIFICATE OF LIABILITY INSURANCE 7/8/2016
<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(ies) must be endorsed. If SUBROGATION IS WAIVED, subgect to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confor rights to the
<br />certificate holder in lieu of such endorsements .
<br />PRODUCER ICO2N.TACT
<br />kY
<br />SelectSolutions Insurance Services, LLC PHCON o EKc : 866-500-6359 FAX Not. (855) 804-8449
<br />#0127711 EMAIL
<br />1350 Carlback Avenue ADDRESS:
<br />Walnut Creek, CA 94596 INSURERIS) AFFORDING COVERAGE NAIC t
<br />INSURED
<br />INsuRER a : Scottsdale Insurance Company- _.. 41
<br />Lien On Me, Inc. INSURER C : Sentinel Insurance Company, Limited 11
<br />465 NORTH HALSTEAD #104 INsuRec� o
<br />Pasadena, CA 9110176021 __ _...._...
<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 />(NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADCaL,.SURR
<br />POLICY NUMBER. MM POLICYEFF
<br />0IYYYY
<br />ta�..ffNYY
<br />EXP
<br />MMIDDY
<br />_..
<br />LIMITS
<br />...EACH
<br />f COMMERCIAL GENERAL LIABILITY
<br />OCCURRENCE $ 1,004,000
<br />CLAIMS -MADE OCCUR
<br />p
<br />7
<br />y
<br />DAMAGE TO RENTED
<br />PR'EMISE'S Pra occurrence
<br />1,000 000 -...�. _..
<br />MED EXP (Any one person)
<br />..
<br />$ 10,000
<br />PERSONAL.&ACV INJURY $ 1,000000
<br />C
<br />Yes
<br />5'7SBAAG'7645 f 811512016
<br />8/1512017
<br />_GEN'L AGGREGATE LIMIT APPLIES PER:
<br />:'
<br />(
<br />GENERAL AGGREGATE .. $.,000.000
<br />_
<br />POLICY ' PRO- L,OC
<br />OJECT
<br />I
<br />.�.-. ....._-
<br />PRODUCTS-COMPIOPAGG $.2,00(D,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />}
<br />COMBINED SINGLE LIMIT $
<br />L.LEa accident)1,000,000 .. ...........
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS .-.. .."1 AUTO'
<br />57SBAAG7845 8!1512016
<br />(
<br />811512017
<br />BODILY INJURY (Per accident) $
<br />__...��.__,�_.M_A_G.$
<br />_. ............
<br />PROPERTY E
<br />DA
<br />{,Per aeclde...
<br />0t ... ..... ..., ...._.-..
<br />i�..,
<br />'� NONOWNED
<br />HVRED AUTOS .. AUTOS
<br />Yes
<br />I
<br />I
<br />!
<br />$
<br />f
<br />UMBRELLA LIAR/ OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />C
<br />.�QEQ
<br />EXCESS LIAB CLAIMS -MADE
<br />..r - .m.. �__...�..
<br />Yes
<br />...'.. 57S�BAAG7645 � 8!15!2016
<br />8115/2017
<br />AGGREGATE $ 1.000.000
<br />....... .. .,.,..,......... ....... .�.�...
<br />✓ RETENTION$ 10.000
<br />$
<br />WORKERS COMPENSATION.....
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />ANY PROPRIETOWPARTNERrEXECUTIVE..
<br />PER '�, 0TH -
<br />STATUTE ER
<br />E.L EACH ACCIDENT $
<br />OFFIOERIMEMBER EXCLUDED?
<br />N 1 A.
<br />E.L. DISEASE - EA EMPLpYEE $
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />--....-,.� ...-_._.....,
<br />F . DISEASE POLICYLIMIT $
<br />B
<br />Professional Liability (Errors and Oftsslcns)
<br />EK13184755 312512015
<br />312512017
<br />I'I $1,000.000 1 $1,000,000
<br />i
<br />DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) rp
<br />Certificate Holder is named as Additional Insured as their interests may appear in regards to General LiabilityfF,Y`"
<br />�1
<br />A: BLIND 72BDDDF9643 1/28/2014 - 1/2812017 $130,000
<br />w
<br />t,r—K I Irut...A I r r1ULLItK. L AN"L.LA I IUIY
<br />City of Santa Ana
<br />20 Civic Center Plaza (m-41)
<br />Santa Ana. CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2414 ACORD CORPORATION. All rights reserved...,
<br />ACORD 25 (2414101) The ACORD name and logo are registered marks of ACORD
<br />
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