2009/07/12 Data Ticket, Inc. Certificate of Liability Insurancet.Henuv 9CI04 UAI II
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 0DATE (MMIDD[Y
8/06/2009YYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ashbrook-Clevidence, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3000 W. MacArthur Blvd., #320 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License #0188788
Santa Ana, CA 92704
INSURED
Data Ticket, Inc. dba: Revenue Experts
4600 Campus Drive #200
Newport Beach, CA 92660
COVERAGES
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Hartford Casualty Company
INSURER B: Granite State Insurance Co
INSURER C:
INSURER D:
INSURER E:
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
ADDT
INSRE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MM/DDIYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
S1 000000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$300 0O0
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
S11,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
PRODUCTS - COMP/OP AGG
s2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
72SBAIA9147
11/01/08
11/01/09
COMBINED SINGLE LIMIT
(Ea accident)
S1,000,000
BODILY INJURY
(Per person)
S
X
BODILY INJURY
(Per accident)
S
X
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
S
$
A
EXCESSIUMBRELLA LIABILITY
X1 OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 10000
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
S1 000000
AGGREGATE
S1,000,000
S
S
S
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
WC009560474
07/12/09
07/12/10
X WC STATU- OTH-
ER
E.L. EACH ACCIDENT IS11,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT I
S1 ,000,000
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.
GtK I IFIGA 1 E HULUtK
City of Menifee
ATTN: Kathy Bennett
29714 Huan Road
Menifee, CA 92586
HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
ATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN
OTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
1POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S14995/M14994 SXL O ACORD CORPORATION 1988
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