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-� 1 ® <br />A� RQ CERTIFICATE OF LIABILITY INSURANCE <br />bATE (MM/DOIYYYY) <br />06/01/2017 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In Ileu of such endorsement(s). <br />PRODUCER <br />Bettis insurance Services, Inc. <br />1725 S. Gaffey Street <br />Second Floor <br />San Pedro CA 90731 <br />N Gary Bettis _ <br />PHONE a (310) 521-40.50 FAX (XI.) s21-alll <br />IAIC. No N.): <br />ADDRESS: <br />• INSURERS) AFFORDING COVERAGE <br />NAIC e <br />INSURERA:State Com ensation ins Fund <br />INSURED <br />Shakespeare by the Sea <br />777 S. Centre Street <br />San Pedro CA 90731 <br />INSURER a: <br />INSURER C_ <br />INSURER o:,,,_ <br />INSURER <br />INSURER F: <br />ccI <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE Of•INSUPANCE <br />A <br />POLICY NU BER <br />POppY� <br />PO/ICY� <br />LIMITB <br />GENERAL LIABILITY <br />q0t Applicable <br />EACH OCCURRENCE <br />S <br />PREMISES Ee dcarren <br />$ <br />COMMERCIAL GENERAL UAaIUTY <br />Mao EXP (Any one Person) <br />S <br />CLAIMS -MADE OCCUR <br />PERSONAL &ADV INJURY T <br />$ <br />GENERAL AGGREGATE <br />$ <br />GENNLAGGREGATE <br />UMITAPPUES PER: <br />PRODUCTS-COMPIOPAGG <br />S <br />S <br />POLICY <br />PRo- LOC <br />AUTOMOBILE LIABILITY <br />of Applicable <br />Ea acrid SIN L LIMIT5 <br />BODILY INJURY (Per person) <br />5 <br />ANY AUTO <br />BODILY INJURY (Per auddenO <br />S <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIREDAUTOB AUTOS <br />AO <br />$ <br />5 <br />UMBRELLA UA9 <br />OCCUR <br />of Applicable <br />ENCE <br />8 <br />WAGGPE�TE.. <br />W <br />EXCESS LIAR <br />CLAIMS -MADE <br />QED <br />REtENTION S <br />5 <br />p <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIAMUTYANY PROPRICTOWPARTNEREXECUtiVE YIN <br />091118-201T <br />3/0?/281T <br />3/UT/203a <br />- GTFI+n PR <br />IDENT <br />5 1, 000, 000 <br />E.LOISEASE-EAEMPLOYEE <br />S 1,000,000 <br />OFFICEWMEMBER EXCLUDED? <br />(Manealoq In NMI <br />NIA <br />E- DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />If yea, descnae under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES (Anaoh ACORD 181, ptltlltionai RemarNs Schedule, I( mare space Is required) <br />This certificate is issued as a matter of proof of workers compensation coverage only. <br />IZJ 6a� . <br />CERTIFICATE HOLDER OANCELLA I IUN �. <br />( ) ( ) SHOULD ANY OF THE ABOVE CSCD PONCELLED BEFORE <br />THE EXPIRATION DATE THERE/, TICE WI IVERED IN <br />ACCORDANCE WITH THE POLIv R OVISIONS. <br />City of Santa Ana-'^ <br />20 Civic Center Plaza AUTHORIZED REP Es JTA t <br />Santa Ana CA 92701 <br />I <br />ACORD 25 (2010105) ©1988-2010 A COR RATION, All rights reserved. <br />INS026 (2ome501 The ACORD name and logo are registered marks of ACORD <br />