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LABELLE MARVIN A-2008-302 REVIEWED BY <br />EiUNICE HEREDIA (PC 3 OF 32) <br />LABEL -2 OP ID: Ti <br />.ar�✓ CERTIFICATE OF LIABILITY INSURANCE <br />DATE IMMIDDNYYY) <br />0712712016 <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, 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 />CONTACT <br />Steve Nourse <br />PHONE FAX <br />Ayc No 818 933-2700 Arc No; 818-933-2701 <br />Van Nuys, CA 91411 <br />Jeanne Blasher <br />E-MAtlL <br />ADDRESS: <br />INSURERS. AFFORDING COVERAGE NAIC tlF <br />COMMERCIAL, GENERAL LIABILITY <br />CLAIMS 7 OCCUR <br />INSURER A:Admiral Insurance Company <br />INSURED LaBelle Marvin, Inc <br />2700 S. Grand Avenue <br />INSURER B: <br />INSURER C: <br />Santa Ana, CA 92705 <br />INSURER D: <br />INSURER E. <br />INSURER F: <br />COVERAGE'S CERTIFICATE NUMBER! RF'lflQhrwI I Kit IARC21= i. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 CLAIM'S,. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDU. <br />UBR <br />POLICY NUMBER <br />MMIDI DYIYYYY' <br />MMIDD[YYYY <br />LIMITS <br />COMMERCIAL, GENERAL LIABILITY <br />CLAIMS 7 OCCUR <br />EACH OCCURRENCE $, <br />DAMRENTPREMISES <br />-MADE <br />Ea accerrenca $ <br />MED EXP(Any one perspn) $ <br />PERSONAL& ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />- <br />POLICY ❑ ,IECTPRCtO LOC <br />GENERAL AGGREGATE $ <br />PRODUCTS - COM PIOP AGO S <br />S <br />OTHERS <br />AUTOMOBILE <br />LIABILITY <br />COM BINED SINGLF LIMIT 5 <br />'.....(Fa accident) <br />BODILY INJURY' )Per person) ''. $ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) '$ <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />PROPERTY DAMAGE <br />Per accvdenl S <br />S <br />UMBRELLA. LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS. LIAB <br />CLAIMS -MADE <br />AGGREGATE S. <br />DED RETENTION $ <br />S. <br />WORKERS COMPENSATIONpER <br />AND EMPLOYERS' LIABILITY Y 1 N <br />ANY PROIPRIETORIPARTNER/EXECUTIVE <br />OFFICERVEMBER EXCLUDED? El <br />NIA <br />OTH- <br />STATUTE F R.. <br />F.L. EACH ACCIDENT $ <br />F.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory in NHb <br />If yes, deschbe under <br />E.L. Dill ASE -POLICY ILIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Liab <br />E0000019€I45-03 <br />06/1612015 <br />0611512016 <br />PerCmlAg 1,000,000 <br />EVIDENCE ONLY <br />RETRO DATE 1/4/2000 <br />Deductibl 25,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS C VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />*EVIDENCE OF PROFESSIONAL LIABILITY INSURANCE ONLY** <br />City of Santa Ana <br />20 Civic Center Plaza <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 P'ROVI'SIONS. <br />AUTHORIZED REPRESENTATIVE <br />—T" 4aw, <br />u 19b0 -Z014 AGORU CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD' <br />