2008/11/01 Data Ticket, Inc. Certificate of Liability Insurance (5)ACORD,, CERTIFICATE OF LIABILITY INSURANCE 08/06/2009rrY'
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:
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 AFFOROED 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.
IN RADD'
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM DD
POLICY EXPIRATION
DATE MM DD
LIMITS
A
GENERAL LIABILITY
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
$1000000
X COMMERCIAL GENERA-_ LIABILITY
DAMAGE TO RENTED
$300OOO
CLAIMS MADE F_x1 OCCUR
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1 000000
GENERAL AGGREGATE
s2,000,000
GE N'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PRO LOC
JECT
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 HIRED AUTOS
X NON -OWNED AUTOS
BODILY INJURY
(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
X OCCUR CLAIMS MADE
72SBAIA9147
11/01/08
11/01/09
EACH OCCURRENCE
$1000000
AGGREGATE
$1 00O 000
$
DEDUCTIBLE
$
X RETENTION $ 10000
B
WORKERS COMPENSATION AND
WC009560474
07/12/09
07/12/10
X WC STATU- OTH-
DRY MITEMPLOYERS'
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
$1 000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I 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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *3n 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
REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S14995/M14994 SXL 0 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