2008/11/01 Data Ticket, Inc. Certificate of Liability Insurancerrr: ,+4f 4741Zn
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE
08/06/2009"`Y'
PRODUCER
Ashbrook-Clevidence, Inc.
3000 W. MacArthur Blvd., #320
License #0188788
Santa Ana, CA 92704
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Data Ticket, Inc. dba: Revenue Experts
4600 Campus Drive #200
Newport Beach, CA 92660
INSURER A: Hartford Casualty Company
INSURER B: Granite State Insurance Co
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
DD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLICY EXPIRATION
DATE MMIDD/YY
LIMITS
A
GENERAL LIABILITY
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
S1 000000
DAMAGES ( Fa occurrence) RENTED
5300 000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$10 000
CLAIMS MADE Fx_] OCCUR
PERSONAL & ADV INJURY
S1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PROJECLOC
T
A
AUTOMOBILE
LIABILITY
ANY AUTO
72SBAIA9147
11/01/08
11/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
S
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
S
ANY AUTO
S
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
S1000000
AGGREGATE
S1,000,000
X1 OCCUR CLAIMS MADE
S
$
DEDUCTIBLE
$
X RETENTION S 10000
B
WORKERS COMPENSATION AND
WC009560474
07/12/09
07/12/10
TH
)( WC S _1MIT ER
E.L. EACH ACCIDENT
IS1,000,000
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
S1,000,000
E.L. DISEASE - POLICY LIMIT
1 $1,000,000
If yes, describe under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is anmed as additional insured as respects to General Liability coverages as their
interest may appear.
City of Menifee
ATTN: Kathy Bennett
29714 Huan Road
Menifee, CA 92586
OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
TE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *In DAYS WRITTEN
TICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
'OSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVE
ACORD 25 (2001/08) 1 Of 2 #S14995/M14994 5AL v M%.vr[v wnvwmM„— I-
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S (2001/08) 2 of 2 #S14995/M14994