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OP ID: YC
<br />44Corrn CERTIFICATE OF LIABILITY INSURANCE
<br />DA11128/2017Yg
<br />11f28V2017
<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(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 lieu of such endorsement(s).
<br />PRODUCER
<br />Nerver Insurance
<br />649 W. Las Tunas Drive
<br />PO Box 1509
<br />San Gabriel, CA 91778.1509 N-2018-032
<br />WESLEY HAMPTON HOUSE
<br />CONTACT
<br />El ,lime Samarin
<br />PH Nfi 626.943_2237 _ u".
<br />Laq, Ne g,n: __- L wm: fi66•?89.1010
<br />EMAIL
<br />AOORESS: jSam
<br />-0
<br />IEBE-1aNBGCOm
<br />ID X:I-1EBE•1
<br />CUSTOMER
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC_A
<br />INSURED Llebert Cassidy Whitmore
<br />_
<br />INSURER A; Sentinel Insurance Company
<br />11009
<br />6033 W. Century Blvd.
<br />Los Angeles, CA 90046
<br />INSURER e: Federal Insurance
<br />_
<br />20261_
<br />_
<br />INSURERC:Aspen Specialty Insurance
<br />10717_
<br />_
<br />INSURER D: PeIGUS Insurance Company
<br />X
<br />INSURERS:
<br />1219412017
<br />12/14/2018..
<br />IN ERF;
<br />e
<br />PERSONAL a AOV INJURY
<br />COVERAGES CERTIFICATE NUMBER: RFVI8ION NIIMRFR-
<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 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 />INSft
<br />LTR
<br />�ADOL
<br />TYPE OP INSURANCE
<br />POLICYNUMSER
<br />POLICY EFF
<br />MMICDNYY
<br />OLICY EXP
<br />MMIOD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACHOCCURRENCE
<br />I 2,000.,00
<br />PRET s's ETd 'EiI, pL_
<br />s 11000,00
<br />A
<br />X COMMERCIALG'ENERALLRMUTY
<br />�C1AIMS-MAOE L AJ OCCUR
<br />X
<br />-72SBAAK0318
<br />1219412017
<br />12/14/2018..
<br />MEDEP(Anyoneperson)
<br />5 10,00
<br />PERSONAL a AOV INJURY
<br />5 2,000,ODC
<br />GENERALAGGREGATE
<br />S 4,000;00
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />X POLICY! F-1PR
<br />1ECTO 1-1 LOC
<br />PRODUCTS -COMPIOPAGG
<br />_
<br />T_ 4,000,00
<br />$
<br />AUTOMOBILE
<br />LIASILrrY.
<br />COMBINED SINGLE LIMIT
<br />(Ea aeaident)
<br />S 2,000;00
<br />ANY AUTO--'
<br />BODILY INJURY leer parson)
<br />S
<br />ALL OWNEU AtfTOS
<br />BODILY INJURY IParacddenl)
<br />5
<br />A
<br />X
<br />SCHEOULEDAUTOS
<br />HIRED AUTOS
<br />72SBAAK0318
<br />12/1412017
<br />12/14/2018
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT) _
<br />$
<br />A
<br />X
<br />NON-OWNEDAUTOB
<br />72SBAAK0318
<br />12/1412017
<br />12114/2018
<br />s
<br />)( I
<br />UMBRELLAUAa
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A—
<br />LIAR
<br />CLAIMS -MADE
<br />7256AAK0398
<br />1211412017
<br />12114/2018
<br />AGGREGATE
<br />$ 2,000,000
<br />TE)XCSSS
<br />DUCTIBLE
<br />$
<br />S
<br />TENTION S 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY ECUTIVE YIN
<br />PROPRJETORIPARTNERIEXECUTIVE
<br />(Mandatory in NH)
<br />If yes, describe under
<br />OESCRIPTONO OPERATIONS 1.
<br />NIA
<br />175-05-95
<br />04/01/2017
<br />04/0912018
<br />X WC STATU• 0TH:
<br />E.L. EACHACCIOENT
<br />S 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,00
<br />E.L. DISEASE POLICY LIMIT
<br />S 1,000,000
<br />C
<br />Pfofessional,Liab.
<br />LRA9AF817
<br />12/10/2017
<br />12/1012018
<br />Per Claim 6,000,00
<br />D
<br />Professional Liab.
<br />XPL409238
<br />AggregateA 5,0001,,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ADOPT, 104,Add(tiona(Renarks Sehsdula, it mora spa.N. le4uead) -' ( ( A () FORM!
<br />Certificate Holder is named as an Additional Insured in regards to attached
<br />General Liability Form SS 00 OB 04 05, per written contract or agreement.
<br />CITYSAA
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<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 />All riohts. reserved
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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