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DATE(MWOD/YYYYI
<br /> CERTIFICATE OF LIABILITY INSURANCE
<br /> 12/21/2016
<br /> THIS 09RTIFICATE 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 I
<br /> REPRESENTAT(VE OR PRODUCER,AND THE,CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certifloate holder Is an ADDITIONAL INSURED,the policy(Ies)most be endorsed. If SUBROGATION IS WAIVED,subject to i
<br /> the terms and condltlons of the polloy,Certain polloies may require an endorsement. A statement on this canificate does not confer rights to the
<br /> oertifloste holder in lieu of such endorsement(s).
<br /> PRODUCES CONTACT Catherine Sariana
<br /> Milestone Risk Management & Insurance Agency AX a 14191 est-1132
<br /> OD . ouarianatamileotonepromise.com
<br /> License No. 0872756 E
<br /> 8 Corporate Park, Suite 130 INSURERS AFFORDING COVERAGE NA16*
<br /> I
<br /> Irvine CA 92606 INSURERA:Btarr Su lus Lines Insurance 13604
<br /> INSURED INSURERB:Genelral Ins Co Of America 024732
<br /> Wayne Perry, Inc. INSusEno:Star Indemnity & Liability Company 3831
<br /> 8281. Commonwealth Ave. INSURERD:Travelers Proper-by Casualty of 025674 j
<br /> INSURER E
<br /> Buena Park CA 90621
<br /> INSURER F;
<br /> COVERAGES CERTIFICATE NUMBER.16/17 Master REVISION NUMBER,,
<br /> THIS IS TO CERTIPY 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 OWCONDITION 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 /> 1 8p TYPEOPINSURANCE A Al. a P LILY NUMBS POL[CYEyy POU2ryyj LIMMS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,00 0,000
<br /> A CLAIMS•MADE X❑OCCUR 100006604?161 12/31/2016 12/31/2017 ES ER acau re ce 300,000
<br /> X Contr. Pollution'Laub. $1,000,000 Each occurrence MED EXP Any one portion) $ 25,000
<br /> X Prof. Liab - Claims Hada 411,000,000 Rauh C103m, PERSONAL a ADV INJURY $ 1,000,000
<br /> GENILACIGREUATE LIMIT APPUES PEW So subject to 02,000,000 GENERALAGGREGATE $ 2,DOD,000
<br /> POLIOY a jEG LOC Polley Aggregate PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> O E ' $
<br /> AUTOMOBILE LIABILITY COMBi ED BIN E LIMIT $ 1,000,000
<br /> dont)
<br /> B R ANY AUTO BODILY INJURY(Per portion) $ i
<br /> ALLOWNED gSCHEDULED 24-�CC-•317015-20 12/31/2016 12/31/2017 BODILY INJURY(Per accldenq $
<br /> AUTOS [ION-0WNED PROPERTY DAMAGE
<br /> HIRED AUTOS AUT03 Per $
<br /> 6
<br /> UMBFTELLALIAB X OCCUR EACH OCCURRENCE 8 9,000_000
<br /> A X EKOESS LIAR CLAIMS-MADE AGGREGATE 9,000,000
<br /> DED I 7t I RErr=w ON s 0 100D336804161 12/31/2016 12/31/2017 $
<br /> WORKERS COMPENSATION X STTMA7UTE ER.,
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETORlPARTNERlEXECUT[YE YIN
<br /> OFFE.LEACH ACCIDENT $ 11000,000
<br /> �ERiMrA6eEREXCLUDED?
<br /> C 1000001961 12/31/21316 12/31/2017 E,LDISEASE-EA EMPLOY $ 1,000,000
<br /> (MrMetary In NHI ,
<br /> I1i3 dasdlbe under
<br /> 6 R OF OPERATIONS below E,LDISEASE-POLICYLiMrr 21000,000
<br /> D Installation Floater 66tl1473C861 12/31/2016 12/31/2017 LIMIT/DEDUCTIBLE $25OR / $2,500 j
<br /> D Rented/Leaaed Egospment 66D1479CO61 12131/2016 12/31/2017 LIMIT/DEDUOTIBLE $1508 / $2,500
<br /> i
<br /> DESCRIPTION OP OPERATIONS l LOCATIONS/VEHICLES(ACORD IDI,AdditMunt Remarks gabodule;may 6e atteote a Boa
<br /> RE: All Operations.
<br /> Cextilicate holder .is named as an additional insured, where re TAU;Un a the
<br /> attached endorsement,
<br /> MAR 2 9 2017
<br /> CERTIFICATE HOLDER CANCELLATI
<br /> D
<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 /> AUTHORIZED REPRESENTATNE
<br /> Teresa Shen/TERESA -
<br /> @ 1998.2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of AGORA
<br /> IN8026(20140)
<br />
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