2008/11/01 Data Ticket, Inc. Certificate of Liability Insurance (4)ACORDTM CERTIFICATE OF
LIABILITY INSURANCE
08/06/2009'
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
INSURER A: Hartford Casualty Company
Data Ticket, Inc. dba: Revenue Experts
INSURER B: Granite State Insurance Co
4600 Campus Drive #200
INSURER C:
Newport Beach, CA 92660
INSURER D:
INSURER E:
r nVPRAnPA
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/DD/YY
LIMITS
A
GENERAL LIABILITY
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERAL. I IABILITY
DAMPREMISAGE TO RENTED
$300 000
CLAIMS MADE 51OCCUR
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY 7 PROJECT LOC
A
AUTOMOBILE LIABILITY
72SBAIA9147
11/01/08
11/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ANY AUTO
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
X HIRED AUTOS
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
$1 000 000
X OCCUR CLAIMS MADE
AGGREGATE
$1,000,000
$
RDEDUCTIBLE
$
X RETENTION $ 10000
B
WORKERS COMPENSATION AND
WC009560474
07/12/09
07/12/10
X WIRY C I IMIT OTH-
E.L. EACH ACCIDENT
$1,000,000
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE- EA EMPLOYEE
$1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I 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 ofMenifee tjCEI�E
ATTN: Kathy Bennett
29714 Huan Road AU6
10 2009
Menifee, CA 92586
cANCELL.AnoN -TU Ways Tor Non-rayment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *10 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
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)1 of 2 #S14995/M14994 SXL O ACORD CORPORATION 19BU
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 (2001108) 2 of 2 #S14995/M14994