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�,,....,�£. SEE GIFTS (KV'VANG LEE) N-2000--00'1 REVIEWED BY: 4,t_ T EUNICE HERE LF 06_il OF 2) OP ID MIR
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM,17©1rYYY)
<br />07/23/2015
<br />TRIS 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) musk 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 endorsements).
<br />PRODUCER
<br />Financial Mgmnk. Network, Inc,
<br />26041 Acero
<br />Mission Viejo, CA 92691
<br />Mark Ray
<br />CONTACT Mark Ray
<br />PHONE FA
<br />A C Na Ext :949-455-0300 JAIC, No :94 9-716"7413
<br />E-MAIL mray@fmncc.com
<br />ADDRESS: Y
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />X
<br />INSURER A : Scottsdale Insurance Company
<br />CPS2259872
<br />INSURED K Lee Gifts.
<br />Jim Lee
<br />INSURER B ;
<br />EACH OCCURRENCE $ 1'.,606,060..
<br />PO Box 2384
<br />INSURER C
<br />INSURER D
<br />Orange, CA 92859
<br />INSURER E
<br />INSURER, F
<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 />INSR
<br />LTR
<br />'.... TYPE OF INSURANCE
<br />'.
<br />SUWR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM1DDffYYY
<br />POLICY EXP
<br />MM1DDIYYYY
<br />'.., LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />X
<br />CPS2259872
<br />07/20/2015
<br />67126/2016
<br />EACH OCCURRENCE $ 1'.,606,060..
<br />DAMAGE TO RENTEU-- PREMISES fEa, occurrence $ 10,000
<br />MED EXP (Any one person) $ 1,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GE,NERALA13GREIATE $ 2,000,000
<br />POLICY ❑ PRO- ISI LOO
<br />!ECT 1
<br />PRODUCTS - C(yMP10P AGO $ 2,6t16,666
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE. LIMIT $
<br />Ea accident
<br />X
<br />ANY AUTO
<br />X
<br />CPS2259872
<br />0712012015
<br />6712612616
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (per accddenk) $..
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />X
<br />PRI pBRTY DAMAGE $
<br />.Per accident
<br />$
<br />UMBRELLA LIAB OCCUR
<br />EACIi OCCURRENCE $..
<br />AGGREGATE $
<br />EXCESS LIAR CLAIMS -MADE
<br />$
<br />17_1DED
<br />RETENTION $
<br />WORKER'S COMPENSATION
<br />AND EMPLOYERS" LIABILITY YIN
<br />ANY PROPRIETOR'PARTNERIEXIECUTIVE
<br />OFFICER+MEMBER EXCLUDED?
<br />❑
<br />N ! A
<br />PER OTH-
<br />STATUTE ER...
<br />E.L. EACH ACCIDENT $
<br />E.L. DISEASE _IEA EMPLOYE - $
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />A
<br />Property Section
<br />CPS2259872
<br />67120/2015
<br />07/2012016
<br />BPP 5,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate holder is added as additional insured with respect to the leased
<br />premises at: Santa Ana Regional Transportation Center, 1000 B Santa Ana
<br />Blvd, Santa Ana, CA 92761. I't is also agreed that this insurance shall be
<br />primary and non-contributory.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit of Santa An,THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City a ACCORDANCE WITH THE POLICY PROVISIONS.
<br />The Depot at Santa Ana.
<br />Alma. Flores
<br />1000 E Santa. Ana Blvd, Ste 108 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701 `K4
<br />O 1988-201'4 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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