Agency Name & Address

St. 97

Commercial Certificate of Insurance

STEVE DUBLER 131 N Tustin #205 Tustin, CA 92780 714-542-1194

Issue Date

(MM/DD/YY)

04/19/2012

Dist. 66

Agent 326

This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies shown below.

Companies Providing Coverage:

Insured
Name & Address

C.L.K VIDEO PRODUCTIONS 7561 Skyview Road Riverside, CA 92509

Company A Truck Insurance Exchange Letter Company B Farmers Insurance Exchange Letter Company C Mid-Century Insurance Company Letter Company D Letter

This is to certify that 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. Limits shown may have been reduced by paid claims. Policy Effective Policy Expiration Co. Type of Insurance Policy Limits Policy Number Date (MM/DD/YY) Date (MM/DD/YY) Ltr. General Aggregate $ 1,000,000 B General Liability 04/13/2013 605096014 04/13/2012 Products-Comp/OPS Commercial General Aggregate $ 500,000 Liability Personal & - Occurrence Version $ 500,000 Advertising Injury Each Occurrence $ 500,000 Contractual - Incidental Fire Damage Only (Any one fire) $ 75,000 Owners & Contractors Prot. Medical Expense (Any one person) $ 5,000 Combined Single Automobile Liability Limit $ All Owned Commercial Autos Bodily Injury (Per person) $ Scheduled Autos Bodily Injury Hired Autos $ (Per accident) Non-Owned Autos Property Damage $ Garage Liability Garage Aggregate $
Umbrella Liability Workers' Compensation and Employers' Liability

Coverages

Limit
Statutory

Description of Operations/Vehicles/Restrictions/Special items:

Each Accident $ Disease - Each Employee $ Disease - Policy Limit $

Additional Insured and Certificate Holder The Mission Inn 3649 Mission Inn Ave Riverside Ca 92501

Certificate Holder
Name & Address

THE MISSION INN 3649 MISSION INN AVE Riverside, CA 92501

Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Authorized Representative
Steve Dubler

Cancellation

56-2492

4-94

Copy Distribution: Service Center Copy and Agent's Copy

H-01