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CERTIFICATE A E: OF LIABILITY INSURAD7 (MM0D,Y YYY�
<br />11
<br />NCE I
<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 INISURERiS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />TEIRM Y.)R CONDITION 01FAINY CON"FRAiCr OR OTHER (00IJIMENT wi"rH RESPICTTO VVf-fl0H THIS
<br />CERTIFIC,AfE MAY BE iSSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCR0ED HEREIN IS SUBJECTT'TO ALL 7HE TERMS
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyi must have ADDITIONAL INSURED provisions or be endorsed.
<br />EXCLUSIONS AND CONMTH)INS OF SUCH POLICIES
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies, may requiire an endorsement. A statement on
<br />this certificate does, not confer rights to the certificate holder in lieu of such endorsement(s).
<br />TYPE OF INSURANCE
<br />Pi XER
<br />CONTAcr
<br />POLICY NUMBER
<br />Aor. Risk Insurance services West, Inc.
<br />�
<br />�NAMI
<br />'FRH -CNE— "-, — [.—FA. i -- ---- 0 05
<br />dii 71�2 (&AT) 361
<br />LIMITS
<br />LOS Aneles ("A Ce
<br />' Of:f
<br />707 wi shire isclulevard
<br />. ........ -(�' ,
<br />_e . ............ .
<br />E-MAIL
<br />0
<br />Suite 2000
<br />A-2016-253
<br />ADOPESS
<br />X
<br />5088210281
<br />Los Angeles CA 901017-0460 USA
<br />EACHOCM .,LJIIRPENC,-
<br />$I., 11000
<br />INSURER(Si AFFORDING COVERAGE
<br />NAW
<br />CLAINi OCCUR
<br />IN:MJRED
<br />INSURER k Nathonal F i f1re tns. ca, of liarltfovilj
<br />20478
<br />NiMdari Miompland ,outions
<br />PJSPREIte. The Continental Insurance corp pany
<br />1, 0001, 000
<br />2401 EaSt Katella Alienile
<br />SLire 300
<br />INSURER c: LeXIngtOn IrlSUrance Company
<br />1194 7
<br />Andheirl CA 92806 USA
<br />INSURER D:
<br />. .............. --.- .. . ....... .
<br />JEM
<br />L--L-2.LE-'!.LL �Y— e � ---
<br />� ---- — ---------- --- —
<br />INSURER E:
<br />INSURER r�
<br />COVERAGES CERT11FICATE NUMBER: 570064388610 REVISION NIUMBER:
<br />THIS HS TO CE R T EY TH AI' THIS POL I (,LIES OF IN $IJ IRA NC E U $T ED, BE LOW' HAVE 9 EEN 15 S IJ E D 7 0 TH E I NS UR ED I E Q ABOVE F 0 R TH E P 01-1 C Y PER K) D
<br />INDICATED. NO TWJ"T'D.J$jr ANDING ANY REQUIREMENr
<br />TEIRM Y.)R CONDITION 01FAINY CON"FRAiCr OR OTHER (00IJIMENT wi"rH RESPICTTO VVf-fl0H THIS
<br />CERTIFIC,AfE MAY BE iSSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCR0ED HEREIN IS SUBJECTT'TO ALL 7HE TERMS
<br />EXCLUSIONS AND CONMTH)INS OF SUCH POLICIES
<br />-11INhITS SHOWN MAY HAVE BEEN REDUCED BY PALD CLAIMS Limits shown airle as, requested
<br />INSI
<br />TR'
<br />TYPE OF INSURANCE
<br />AUSUC)
<br />JW I
<br />SUBRI
<br />WV'D
<br />POLICY NUMBER
<br />POLICY E FF
<br />MWE)i �
<br />� ii PO LIT Y I
<br />MsnDO0(yyy`I
<br />LIMITS
<br />0
<br />X COMMERCIAL CENERALLIABILITY
<br />5088210281
<br />EACHOCM .,LJIIRPENC,-
<br />$I., 11000
<br />CLAINi OCCUR
<br />1, 0001, 000
<br />JEM
<br />L--L-2.LE-'!.LL �Y— e � ---
<br />� ---- — ---------- --- —
<br />ME D EXP (614 i y tine pe rsD,,)
<br />$15,0010
<br />PER SON AL,% AM/ INJURY
<br />$1_000,000
<br />..... . .. . . . .......
<br />rEN't ;,':��GREGArE LIMIT APPLIES PER
<br />GENFRAI, AGGIREC]ATE
<br />.. .......... .
<br />I)00
<br />� a': 1 i_.. P-1: l'OC
<br />f Rit[MIG"1 1XWOF,DPAGQ
<br />S2, 000, 0100,
<br />AAUTOMOBILE
<br />LIABILITY
<br />6021
<br />1 /09/20 16
<br />JL/09/2017
<br />CQMEINED SINGa,tumir
<br />S �L, o0o, 000
<br />ANY Av i�)
<br />r4,juifq','f Pei, perion)
<br />0
<br />0"vNEII) CHEDU� E[)
<br />AU ros 0 rqijUTOS
<br />I IRFr) AUTOS 1'40N-C1NNED
<br />ONLY Ai,A r os
<br />. . . ....
<br />(LJMRRE"I��7A LIAB OCCU R,
<br />C R
<br />FACH -NCE
<br />_'S L JO'B CLFkWS-MADE
<br />AGGREGATT_
<br />rjrt CrF NrIGN
<br />8
<br />WORKERS 00IMPENSATK)N AND
<br />602�647472
<br />777777
<br />1110912017
<br />77
<br />EMPLOYERS LIABi Y � IN
<br />AOS
<br />�'FP
<br />L7 il
<br />a
<br />ANY,PRDPREr0R;PAl;,TNER EXECUNI/F
<br />OFF MR1dPiABFR EXCI UDEDI EF]
<br />NaA
<br />60�05411x72
<br />11 u e 2 o ro
<br />11 a 2o. �I
<br />E L EAC:� i Ai�XADENT
<br />'S 1, 01001, 00O
<br />. ...... -.—
<br />pMaadawryri NH
<br />CA
<br />000
<br />If yes disl5cnbe under
<br />DESCRIPTK",� OF OPERA I IONS belo�
<br />F T";. L kC:y UMIT
<br />S1,000,00o
<br />C Pi-nf
<br />Ar'Chi I&Eng
<br />1 �/G-4/20 � 6 Per Claim S] , 0001,000
<br />0216 17491� 17
<br />11
<br />S.riz app I ies per po f i y ter r kip & rood uons i Agg rega tv.
<br />1
<br />SIR o0o
<br />M,`,$CRIPTJ()N ()F OPERArIOWS i LOCA NONS i VEMCLES IACORD tOl, Addkiwral Fi SchoduIp. may be a"ackall 0 more splive is rii
<br />I E:� As -Nee�led r ra I n f nq Cou r s es and EXe rr, � ses
<br />, CiLy of Sanila Aria, its off�Icers, ernp �jyees agents, vokinreers and
<br />I
<br />reMresentat i ver 5 are irlclwderd a�Si Additioirl,,'O
<br />Kinsured with respect to the Gerli�ral 0001I it'y anO ALItOrntfll)IIle I Ity
<br />the r;eneraI i iabiHty policy evidenced herein
<br />Is Prfmary arld NOTT-Contribjutory to, cither insurance avaVlabie, hrl accordance with
<br />the policy prclvislonis.
<br />CERTIFICATE
<br />CANCELLATION
<br />HOLDER
<br />X..j
<br />SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPRATION DATE THEREOF, NOTICE PALO., BE DELIVERED 04 ACCORnATXE WITH THE
<br />POLICY PROVIWONS
<br />i r V of ;al TI rr a Afli,4
<br />AUTHORIZED REPRESENTATIVE
<br />Attli 1 clerk of, Chas C1 t y Col)ncitl
<br />20 (JvIc Center Plaza(Y-30)
<br />no BOX 1988
<br />AMI/Ylt"III
<br />Saii AnrtA CA 92701 IA
<br />LIWIM
<br />Cr)l 988-2!015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and lio7p, 47, registered marks of ACORD
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