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~,~`~M CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) <br />06/06/2007 <br />PROIl~jCER• (e61)287-4195 <br />James G Parker Ins Assoc <br />License #0554959 FAX (661)254-5875 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />27200 Tourney Blvd #275 <br />Santa C1 arita, CA 91355 <br />Robyn Thorne <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED Mi dori Gardens , Inc INSURER A: RedWOOd Fire & Casual ty Ins Co <br />3231 Main St c~ I1 / <br />~ <br />~ INSURER B <br />Santa Ana, CA 92707 ~ -pcU <br />W ' ~ INSURER c: <br /> INSURER D: <br /> INSURER E. <br />C VERA^v ES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD' TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ <br /> CLAIMS MADE ^ OCCUR MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ <br /> POLICY jE ~ LOC ~, <br /> AUT OMOBILE LIABILITY ..._ -~ r° t ~~_,~ _ ~.; f, , :. <br />COMBINED SINGLE LIMIT <br /> <br />ANY AUTO <br />(Ea accident) $ <br /> ALL OWNED AUTOS ,.... BODILY INJURY <br /> <br /> <br />SCHEDULED AUTOS ~ <br /> <br />~ <br /> <br />--° ~ --- ~... <br /> <br />(Per person) <br />$ <br /> HIRED AUTOS ,.~„i,. , <br />BODILY INJURY <br /> <br />NON-OWNED AUTOS <br />- <br />(Per accident) $ <br /> PROPERTY DAMAGE <br /> $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC <br />OTHER THAN $ <br /> AUTO ONLY AGG $ <br /> EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ^ CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br />/ WORKERS COMPENSATION AND <br />' W6633892 06/01/2007 06/01/2008 X WC sTATU- oTH- <br /> <br />A EMPLOYERS <br />LIABILITY <br />ANY PROPRIETORlPARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1, OOO, OOO <br /> OFFICERlMEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1 , OOO , OOO <br /> If yes, describe under ----~--- -------~ <br /> SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 , 000 , 000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS !LOCATIONS !VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />ob: City of Santa Ana <br />~°Workers' Compensation: 10 day notice to insured of cancellation for non-payment of premium/non- <br />eporting of payroll. No other modification to the Cancellation section in this certificate will apply <br />o Workers' Compensation coverage. Employers Liability Limit $1,000,000 (Per Accident/Aggregate Policy <br />imit) <br />City of Santa Ana <br />Attn: Jerry Jeffries <br />20 Civic Center Plaza <br />Ross Annex (M-21) <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />'°3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE ~-~ C'7 <br />ET <br />ACORD 25 (2001108) FAX: (714)647-5069 ©ACORD CORPORATION 1988 <br />