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OP ID: KA <br />CERTIFICATE OF LIABILITY INSURANCE <br />1 op 04124 oom4rl <br />a/za/zala <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 Phone: 858. 457 -5720 <br />Rubin Insurance Agency Inc. <br />6363 Greenwich Dr, #120 Fax: 858. 457 -5729 <br />CA #0645355 San Diego, CA. 92122 <br />Michael Rubin <br />„ `Poe Q/3 — (3//c? . ®O 9 <br />/)/ �i cA OG <br />CONTACT <br />PHONE FAX <br />A No Ext: AIC No): <br />EMAIL <br />ADDRESS: <br />PRODUCER B &DTO -1 <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC Ii <br />INSURED B &D Towing, Inc <br />Balcaceras and Davalos Towing <br />1502 N Susan Street <br />Santa Ana, CA <br />INSURER A: Insurance Company of the West <br />27847 <br />INSURER B: <br />INSURER C <br />$ <br />INSURER D <br />$ <br />INSURER E: <br />$ <br />INSURER F: <br />$ <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 />R <br />TYPE OF INSURANCE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />60 Civic Center Plaza <br />POLICY NUMBER <br />MMI�OY� <br />MMIIOOVIYVYY <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACH OCCURRENCE <br />$ <br />PREMISES Ea occurrence <br />$ <br />MED EXP(Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY PRO LOG <br />PUT <br />PRODUCTS COMP /OP AGO <br />$ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANVAUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY (Per Person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />$ <br />UMBRELLA LAS <br />EXCESS LIAB <br />OCCUR <br />CLAIMB-MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />$ <br />A <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY <br />ANY PROPRIETOMPARTNERIEXECUTIVE YIN <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />WS0502471100 <br />10/01/2013 <br />10/0112014 <br />X WC STATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ 1,000,00 <br />F.L. DISEASE - EA EMPLOYEE <br />$ 1,000,00 <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD IDI, Additional Remarks Schedule, If more space Is required) <br />Proof of insurance. Waiver of subrogation endorsement WC990637(5 -02) Nn <br />MV ('��✓1� )t7V a� <br />I V� R J <br />CERTIFICATE HOLDER CANCELLATION <br />CITYSA <br />City f Santa Ana <br />Y <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />60 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE�— <br />ACORD 25 (2009/09) <br />© 1988.2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />in a. <br />