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A,e-"'/l v3l^f� 'I'llCERTIFICATE QF LIABILITY INSURANCE rMoai262017 THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOTAFFIRMATIVELYOR NEGATIVELY AMEND, EXTENU ORALTER 1'HE COVF-RAGEAFFORDP.D BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTEA CONTRACTBET WREN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; Ifthe cordecate holder Is an ADDITIONAL INSURED, the pollcy(las) must have ADDITIONAL INSURED provisions or he endorsed. IfSUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, contain policlesmayrequire an ondorsement.Astatementon this certificate doesnotconfer Narrate the certlBcnteholder In lieu ofsuch endorsoment(s). ....,...........,......»_, PRODUCER CONTACT PARKSIDE INSURANCE SERVICES, INC 18511 Bmokhurst $t NAME: CUYEN HOANG PHONE (A/C, NO, EXT): 714-705.0453 FAX (A/C, Noy 714.839.7381 Fountain Valley CA 92708 E-MAIL ADDRESS: PARKSIDEIN8@GMAIL.COM INSURER(S)AFFORDING COVERAGE NAICF INSURED INSURERA: EMPLOYERS PREFERRED INSURANCE CO ELIXALOE, OUIL.LERMO INSURERS: INSURER01 DBA; SUPER ANTOJITCS EXPRESS 1702 N BRISTOL ST STE D INSURERS: INSURERE: SANTA ANA CA 02706 INSURERF: w VtKFW1Lg1t NVMetR: REVISIO14NUMHER: THIS ISTO CERTIFYTHATTHE POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANOINGANY REQUIREMENT, TERM OR CONDITION OFANYCONTRACT OR OTHER OOCUMENT WITH RESPECTTO WHICH THIS CERTIPICATE MAYBE ISSUED OR MAYPERTAIN. THE INSURANCEAFFORDED HYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE ADDn. INSD SURR me POLICY NUMBER POLICY SEE (MM/DD/YYYY) POLICYEXP (MM/DD/YYYY) LIMITS COMMERCIALGENERALLIABILIYY � � EACH OCCURRENCE $ CLAMS -MADE OCCUR DAMAOFTO RENTED PREMISES(Ea Occurrence) $�� MED EXP(AnypPO person) $ PERSONAL&ADY INIURY $ GEN'L AGGRErGATIE LIMITAPPLIES PER: GEN ERAL AGGREGATE $ POLICY PROJECT LOC a PRODUCTS-COMP/OP AGG $ OTHER: $ AU'POMOBILE LIABILITY ANYAUTO _ ° COMBINED SINGLE LIMIT (Eaaccldorn) $ BODILY INJURY (Per person) $ OWNEDAUTOS SCHEDULED ONLY AUTOS HIREp AUTO5 NON-ON/NED!':3.� ONLY AUIOSONLY �\ �� �a�`'� a -gym ." BODILY INJURY(Peracrvdent)$ PROPERTY DAMAGE (Peraecidenp $ $ UMBRELLALIA3 OCCUR �r EACHOCCURRENCE $ EXCESS LIAR CLAIMS -MADE �.T 1 AGGREGATE $ SfD RETENTION$ ._-,.. $ ._... WORNER5COMPENSATION AND EMPLOYERS'LIAWLITY X PER STATUTE OTHER $ A ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER E%CLUDEDI(Mandatory In NH) Y N/A EIG229134900 11/01/2016 11/01/2017 F-.L. HIGH ACCIDENT E 1,000,000 E.L, DISEASE - EA EMPLOYEE 11000,000 Yves, descolueuaderDESCRIPTION OF OPERATIONShebw E-L. DISEASE-POUCYLIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Audi III Remarks Schedule, May be attached Rumors spare b required) v Certificate holder, its officers, agents, and employees are named as Additional Insured . Should any of the above described policies be cancelled before the expiration date thereof, the issuing Insurer will endeavor to mall 30 days written notice to the additional Interest named below, but (allure to mail such notice shall Impose no obligation or liability of any kind upon the Insurer, Its agents or representatives. 1D- days notice of cancellation for nonpayment CERTIFICATE HOLDER CANCELLATION ----Urlyot Santa Ana SHOULD ANY OF TH E ABOVE DESCRI BED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn: PRCSA DATE THEREOF NOTICE WILL BEOELIVERED IN ACCORDANCEWITH THE POLICY PROVISIONS, 20 CIVIC Center Plaza M-23 Atabq&? 6ESENTATIVE � Santa Ann «r".A.�2ZOL..�._.._.w.,. ........_...� _,.._...........,........ _..._............-...,..,_,._. ACORD 25 (201603) ©1988-2015 ACORD CORPORATION, All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD