2009/07/12 Data Ticket, Inc. (5) Client#: 12154 DATTI
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' POLICY EFFECTIVE POLICY EXPIRATION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM DD DATE MM DD LIMITS
A GENERAL LIABILITY 72SBAIA9147 11/01/08 11/01/09 EACH OCCURRENCE $1000000
X COMMERCIAL GENERA-_LIABILITY DAMAGE TO RENTED $300 OOO
CLAIMS MADE F_x1 OCCUR MED EXP(Any one person) $1 O 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 72SBAIA9147 11/01/08 11/01/09 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILITY 72SBAIA9147 11/01/08 11/01/09 EACH OCCURRENCE $1000000
X OCCUR CLAIMS MADE AGGREGATE $1 000 000
DEDUCTIBLE $
X RETENTION $10000 $
B WORKERS COMPENSATION AND WC009560474 07/12/09 07/12/10 X WC STATU- OTH-
DRY MITEMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 OOO OOO
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER 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/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.
CERTIFICATE HOLDER CANCELLATION *10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Menifee DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *3n DAYS WRITTEN
ATTN: Kathy Bennett NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
29714 Huan Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Menifee,CA 92586 REPRESENTATIVES.
AUTHORIZED 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