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LABELLE MARVIN A-2008-302 REVIEWED BY
<br />EUNICE HEREIDIA (PG 1 OF 32)
<br />LABEL -2 OP 10: TI
<br />tl'
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />(MMIDDIYYYY)
<br />70712712015
<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 CONTRACTBETWEEN 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( es) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Momentous Insurance Brokerage
<br />5990 Sepulveda Blvd, Suite 550
<br />Van Nuys, CA 91411
<br />Blasher
<br />...CONTACT
<br />Dafen t�'Neill
<br />HONE
<br />PHONE FAX
<br />No, Ext :818-033-2700 Arc No): 818-+933-2701
<br />ss: doneill m17tl,kai.C4n1
<br />ADDRESS: Jeanne
<br />INSURERS AFFORDING COVERAGE NAIC p
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS DE OCCUR
<br />INSURERA: Sentinel Insurance Company
<br />INSURED LaBelle Marvin, Inc
<br />INSURER 13: Hartford Accident and
<br />2700 S. Grand Avenue
<br />Santa Ana, CA 92705
<br />INSURER C: State Compensation Ins. Fund
<br />DAMAGE T RENT
<br />PREMISES Ea occurrences. $ 1,000,.000
<br />ME;D EXP (Anyone person) $, 10,000
<br />INSURER D :
<br />INSURER E:
<br />INSURER F'
<br />COVERAGE'S 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SBR
<br />VVVDPOLICY'
<br />NUMBER
<br />POLICY EFF'
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS DE OCCUR
<br />X
<br />72SBANU6283
<br />0611612015
<br />06/1612015
<br />EACH OCCURRENCE S 1,000,000
<br />DAMAGE T RENT
<br />PREMISES Ea occurrences. $ 1,000,.000
<br />ME;D EXP (Anyone person) $, 10,000
<br />PERSONAL & ADV INJURY SS.. 1:000,400
<br />GEN'L AGGREGATE LIMIT APPLIFS PERS
<br />POLICY ® JECT TOO
<br />GENERAL AGGREGATE $ 2:000,000
<br />PRODUCTS - COMPIOP AGO $ 2,000,{}0
<br />Emp Ben. $ 1,000,000
<br />OTHER:
<br />AUTOMOBILE LIABILITYOMBIN
<br />EDtSINGLE LIMIT $ 1,000,000
<br />BANY
<br />AUTO
<br />72UECAH0364
<br />0611612015
<br />06/1612016
<br />BODILY INJURY (Per person) s
<br />ALL OWNED SCHEDULED
<br />AUTOS X AUTO'S
<br />BODILY INJURY (Per accident) $
<br />X* HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE s
<br />Per accident
<br />$
<br />X UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE s 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE,
<br />72SBANU6283
<br />0611612015
<br />06116/2016
<br />AGGREGATE s 1,000,000
<br />DED I X I RETENTION '$ 10,000
<br />5
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Ya
<br />ANY PROPRtETORIPARTNER/EXECUTIVE
<br />OFFICEWMEMBER EXCLUDED?
<br />N 1 A
<br />9133426-15
<br />0611612015
<br />0611612016
<br />PER X ''.... STATUTE OT H-
<br />E.L. EACH ACCIDENT S 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE s 1,000,000
<br />(Mandatory in NH)
<br />(I yes, describe under
<br />DESCRIPTIONOFOPERATIONSrelaw
<br />E1.DISEASE -POLICY LIMIT I S 1,000,000
<br />DESCRIPTON OF OPERATIONS d LOCATIONS I VEHICLES (ACORD 1'.41, Additional Remarks Schedule, may be attached if more space is required'..)
<br />City of Santa Ana,,its officers, employees, agents, volunteers and
<br />representatives are named as additional insureds ("additional insureds")
<br />with regard to liability and defense of suits arising from the operations
<br />and eases performed by or on behalf of the named insured. :Additonal insured
<br />and primary and non -Contributory per form SS00080405.
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana„ CA 92701'
<br />Iltwa►"I
<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 />T -": C �-ttw, -
<br />1988-2014 ACORD CORPORATION, AIII rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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