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ACORD CERTIFICATE OF LIABILITY INSURANCE <br />TM. <br />DATOSO92o 4vvY) <br />PRODUCER Phone: (714) 9013494 Fax: (714) 901 -3495 <br />BEACHVIEW INSURANCE BROKERAGE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />5011 ARGOSY AVENUE #15 <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />HUNTINGTON BEACH CA 92649 <br />POLICY NUMBER <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />/V o I y" 0 S <br />Agency Laid OG47892 <br />GENERAL LIABILITY <br />INSURED <br />INSURERA: General Casualty Insurance <br />06104115 <br />FORENSIC NURSE SPECIALIST, INC. <br />INSURER 8: <br />DAMAGE TO RENTED <br />PREMISES Ea occursrce <br />3373 Cerritos Avenue <br />Los Alamitos, CA 90720 <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />MED. EXP (Any one person) <br />$ 10,000 <br />COVERAGES <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 CONTRACT OR 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 <br />LTR <br />ADD' <br />INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MMIDI <br />POLICY EXPIRATION <br />DATE MMIDDIW <br />LIMITS <br />GENERAL LIABILITY <br />CFB1058360 <br />06/04/14 <br />06104115 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occursrce <br />$ 300,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR <br />MED. EXP (Any one person) <br />$ 10,000 <br />PERSONAL B ADV INJURY <br />$ 2,000,000 <br />A <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS- COMPADPAGG. <br />$ 4,000,000 <br />PRO- <br />POLICY JECT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />$ <br />BODILY INJURY <br />(Per accident) <br />$ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />$ <br />ANYAUTO <br />AUTO ONLY: AGO <br />$ <br />EXCESS I UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />OCCUR 11 CLAIMS MADE <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />we TORY srnro- OTHER <br />LIMITS <br />C.L. EACH ACCIDENT <br />$ <br />%ECUTIVE <br />ANYCERTMEMBER <br />E. L. DISEASE -EA EMPLOYEE <br />$ <br />XCLUDEE <br />oFPlcewmemaere ExcwpeDT <br />If PROVISIONS mmw <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />OTHER: <br />DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />Certificate holder is named as an additional insured per the attached 154875 endorsement. Waiver of sub also applies in favorAf�Certificate <br />holder per attached form SP 0497 0 - . -o <br />rA 6k!�� <br />(J `= ry� <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />60 Civic Center Plaza <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />Santa Ana, CA 92701 <br />Attention: <br />AUTHORIZED REPRESENTATIVE yl]'c- -,°��� <br />`-' Doi_ non M.CCyyphers <br />ACORD 25 (2001108) Certificate # 9884 © ACORD CORPORATION 1988 <br />