2017/02/05 ADL Planning Associates Certificate of Liability InsuranceAnl PI AN-01
IZHANG
CERTIFICATE OF LIABILITY INSURANCE
DATE /Y
17
os02/20o2/207
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER License # 0757776
Carlsbad, CA - MMA - HUB International Insurance Services Inc.
1903 Wright Place
Suite 280
Carlsbad, CA 92008
caNTACT Kellie Winer
NAME:
PHONE 760 707-5649 FAXNo):
(A/C, No, Ext):
E-MAIL Kellie.Winer@hubinternational.com
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Sentinel Insurance Company,Ltd.
11000
INSURED
ADL Planning Associates
Anthony Lawson
2979 State Street, Suite C
Carlsbad, CA 92008
INSURER B: Hartford Underwriters Insurance Company
30104
INSURER C: Scottsdale Indemnity Company
15580
INSURER D
INSURER E
INSURER F :
REV!-5!QN NI IMRFR,
COVLKAUES t,rzm 1 ir'il+H I C IYUMU LIB. "- "-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
A
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
ADDL
IN
X
SUER
D
POLICY NUMBER
72SBATU6511
POLICY EFF
06/1512017
POLICY EXP
D
06/15/2018
LIMITS
EACH OCCURRENCE
S 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
1,00,000
$
MED EXP An one person)S
10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRCT O 1-1LOC
JE
GENERAL AGGREGATE
2,000,000
$
PRODUCTS -COMP/OP AGG
$ 2,000,000
/�
OTHER:
AUTOMOBILE LIABILITY
Ea aBadeDtSINGLE LIMIT
S
$ 1,000,000
BODILY INJURY Perperson)
$
ANY AUTO
72SBATU6511
06/15/2017
06/15/2018
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON-OVJNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS MADE
DED RETENTION $
$
B
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Professional Liab.
N/A
72WECZH4038
EK13222201
02/05/2017
05/24/2017
02/05/2018
05/24/2018
X SO TATUTE ERH
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYE
1,000,000
S
E.L. DISEASE -POLICY LIMIT
Per claim/aggregate
1,000,000
$
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is named Additional Insured as per written contract perform SS 00 08 04 05 attached to the policy. Coverage is primary with respect to the
City and its officers, officials, employees and volunteers .
City of Menifee
29714 Haun Rd
Menifee, CA 92586
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) lcJ TyiStS-LU ID H�.vrtu �.vtcrvr�r+I IVI\. r�u rrynw ��"
The ACORD name and logo are registered marks of ACORD