2011/07/12 Data Ticket, Inc. Certificate of Liability InsuranceACORDT,., CERTIFICATE OF LIABILITY INSURANCE 0DATE (MM/DDf
7/06/2011 YYY)
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 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Hartford Ins CO of the Midwest
Data Ticket, Inc. dba: Revenue Experts
INSURERS:
4600 Campus Drive #200�;f'�7:t
INSURER C:
Newport Beach, CA 92660 INSURER D:
INSURER E:
fK��q�.7e[NX�
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 MM/DD/YY
POLICY EXPIRATION
DATE MM/DDIYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
S
MERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PR
S
MED EXP (Any one person)
S
DCOM
CLAIMS MADE OCCUR
PERSONAL & ADV INJURY
S
GENERAL AGGREGATE
S
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
S
POLICY PRO-
JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
S
BODILY INJURY
(Per person)
S
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
S
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
S
ANY AUTO
S
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
S
AGGREGATE
S
OCCUR CLAIMS MADE
S
S
DEDUCTIBLE
$
RETENTION S
WORKERS COMPENSATION AND
57WECZY4666
07/12/11
07/12/12
-
X WC STATU- OTHFR
ORYA
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
S1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Menifee
ATTN: Kathy Bennett
29714 Huan Road
Menifee, CA 92586
L:ANC:LLLAIJUN -lu UaVS Tor NO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *in DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 Of 2 #S19747/M19719 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 #S19747/M19719