Laserfiche WebLink
0 0 <br />-6� bF CERT l��C ATE OF UARILITY ��1�URANC EEl/3/2012Y� <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 polley(ies) must he endorsed. if SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certafn 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 />Milestone Risk Management & Insurance Agency <br />License No_ OB72766 <br />S Corporate Park, Ste 130 <br />Irvine CA 92606 <br />CONT Teresa Shen <br />PAONE (949)852-0909 �Acf NQ: (94958521131 <br />aoosLrss:ashen@mi.lestonepromise.com <br />INSURERS AFFORDING COVERAGE NAIL# <br />INSURERA:Starr Surplus Lines Ins. Co. 13604 <br />INSURED <br />Wayne Perry, Inc. <br />8281 Commonwealth Ave. <br />Buena park CA 90621. <br />INSURER BAmerican Economy Inc. Co. 19690 <br />fNSURERG -Federal Ills. Co. 2028-. <br />INSURER D: <br />INSURER E : <br />INSURER F,. <br />COVERAGES CERTIFICATE NUMBER:11/12 Master REVISION NUMBER: <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 CON DITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />-NSRADD <br />LTA <br />7YPEOFINSURANCs: <br />SUER <br />POLICYNU1113ER <br />POLICY EFF <br />MMJDD/Y YY <br />POLICY EXP <br />MMIDDiYYYV <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />PREMSES Ea occurrence $ 300,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE Q OCCUR <br />ST.SL�IL72023211 <br />12/31/2011 <br />2/31/2012 <br />MED EXP Any one person) $ 25,000 <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMITAPPLIES PER: <br />PRODUCTS- COMP/OPAGG $ 1,000,000 <br />POLICY X PRO' LOC <br />$ <br />B" <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />02CE22508901 <br />- <br />12/31/2011 <br />- <br />2/31/2012 <br />COMBfNED SINGLE LIMIT <br />E., fdent S 1 OOG 000 <br />BODILY INJURY (Per persan) $ <br />BODILY INJURY ld$ <br />Peracceni ) <br />HiAED AUTOS NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE $ <br />Per accident <br />Cam .I Call.Ded. $ 1 000 <br />UMBRELLALIAB <br />X OCCUR <br />EACH OCCURRENCE 5,000,000 <br />Is <br />AGGREGATE $ 5,000,000 <br />A <br />�{ EXCESS LIAB <br />CLAIMS -MADE <br />51,sTx IY73417211 <br />2/31/2011 <br />12/31/2012 <br />DED X RETENTION$ U <br />$ <br />G" <br />WORKERS COMPENSATION <br />AND EMPLOYERS, LIABILITY YIN <br />ANY PROPRIETOR/PARITNERIEXECU]IVE <br />Mandator hi NH) EXCLUDED? <br />Y <br />f yyes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />0044727227 <br />12/31/2011 <br />12/31/2012 <br />n v WC STATU- 1ER, <br />A <br />- <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE $ 1 000,000 <br />E.L. DISEASE - POLICY LIMIT $ 11-n <br />000, 000 <br />A <br />Professional Liability <br />SLSTMXL72023211 <br />12!31/201112/31/2012 <br />Llmit(per Claim) $1.,000,000 <br />A <br />Pollution Liability <br />SLSLMIL72023211 <br />12/31/201112/31/2012 <br />Limit (Per Claim) $1,000,0(10 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES (Attach ACORD 101, Additional RernmPs Schedule, If more space is required) <br />CERT it ICATE BOLDER CANCELLATION <br />* PRO0 ONLY** <br />ACORD 25 (2010/05) <br />I NS025 (20i ou5 .Oi <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BI; CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Sariana/TERESA <br />O 1988-2010 ACORD CORPORATION, All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />