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A, " a DATE IMM;oD1YYYYl
<br />�. CERTIFICATE OF LIABILITY INSURANCE 1112412015
<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 />PRODUCER
<br />Barbary Insurance Brokerage
<br />280 California Street, Suite 700
<br />San Francisco CA 94111
<br />INSURED
<br />Shift (Design, Inc.
<br />2655 Harrison Street
<br />San Francisco CA 94110
<br />WEARE-1
<br />rnNIGD A r:GC r FDTICIr ATF Kit nuicicD• 7OAr-rn1A7') OM11Cln1.' xui ueammn..
<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 />NAME: Paul Rogers
<br />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 />PHONE N , Extl.415-788 4700
<br />(AIC, Nol. 415-788-4701
<br />E-MAADDRESS; Paul @barbaryinsuraIcorn
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY Y 2015-42084- NPO . 1213/2015 12!3/2016
<br />INSURER(S) AFFORDING COVERAGE.
<br />MAIC #
<br />.....INSURER
<br />INSURER A;Nonprofits Ins Alliance of CA
<br />524126 .....
<br />B ;North American Elite
<br />$20.,000
<br />'.... _...
<br />INSURER C:
<br />$1,000,000 _...........
<br />GERL AGGREGATE LIMIT APPLIES PER: '.,
<br />INSURER D::
<br />$2.000,000
<br />X. POLICY PRO-
<br />JECT LOG
<br />INSURER E
<br />$2,000,000 ..._. .._.
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<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
<br />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 TYPE OF INSURANCE `ADDL SUBR. _.. POLICY EFF...... POLICY EXP
<br />LTR '.. INSD WVD'. POLICY NUMBER MM/DDffYYY MMIDDIYYYY
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY Y 2015-42084- NPO . 1213/2015 12!3/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />_... CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES IEaaccurrence).
<br />....
<br />$500,000 ......_
<br />MED EXP (Any one person)
<br />$20.,000
<br />'.... _...
<br />PERSONAL &Al INJURY
<br />$1,000,000 _...........
<br />GERL AGGREGATE LIMIT APPLIES PER: '.,
<br />GENERAL AGGREGATE
<br />$2.000,000
<br />X. POLICY PRO-
<br />JECT LOG
<br />PRODUCTS - COMPIOPAGO
<br />$2,000,000 ..._. .._.
<br />OTHER w
<br />Liquor Liability
<br />$1,000,000
<br />AUTOMOBILE LIABILITY .
<br />t(Ea
<br />COMBINED SINGLE LIMIT
<br />accident)
<br />$
<br />ANY AUTO
<br />BODILY INJURY (Per Person)
<br />$
<br />' 6,
<br />ALL OWNED S'TOSIJLED *.q ,r
<br />AUTOS AUTOS �
<br />.......NONOWNED
<br />BODil INJURY (Per acddenI)
<br />....
<br />$
<br />WIR=DAUTCS -„yr,
<br />PROPERTY DAMAGE
<br />$
<br />(Peraccident}„..
<br />UMBRELLA LIAR OCCUR
<br />EACHOCCURRENCES
<br />_...
<br />000
<br />EXCESS LIAR CLAIMS -MADE p"� M1ji
<br />....... ..
<br />AGGREGATE
<br />.... ...
<br />$
<br />DED RETENTION $ '....
<br />$
<br />WORKERS COMPENSATION
<br />PER GTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />STATUTE ER_
<br />....
<br />ANY PR©PRIETORIPAR I NER/EX'ECUTIVE
<br />E.L. EACH ACCIDENT
<br />$
<br />OFFICEWMEMBER EXCLUDED? []N NIA
<br />......
<br />'... (Mandatory in NH) '..,. '......
<br />E . DISEASE - EA EMPLOYEE'.,..
<br />$
<br />If yes, descdbe under
<br />....._
<br />DESCRIPTION OF OPERATIONS below '..
<br />E.. L_ DISEASE - POLICY LIMIT
<br />$
<br />B Commercial Properly CWBOD135900142084 12/312015 12/312016
<br />BPP Limit
<br />$10,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />City of Santa Ana is named as Additional Insured as required by written contract.
<br />I.CK I ir'11.,rA 1 C r1CJLLiCfC k A4Nk tL.L.A I IUN
<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 (PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />I
<br />O 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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