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DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/19/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER CONTACT Robert Ford
NAME:
Regency Business Ins. Sol./Tri Canyon Ins. Srv. PHONE (949)393-4311 FAX (949)274-4182
(A/C, No, Ext): (A/C, No):
26895 Aliso Creek Rd E-MAIL robert@regency1insurance.com
ADDRESS:
B794 INSURER(S) AFFORDING COVERAGE NAIC #
Aliso Viejo CA 92656 INSURER A :Ohio Casualty Ins. Co.
INSURED INSURER B :Everest National Ins Company 10120
DIAMOND ALLIED SERVICES LLC, DBA: Certapro Painters INSURER C :Liberty Mutual Agency Corporation
2237 N 36th Street INSURER D :
INSURER E :
Phoenix AZ 85008 INSURER F :
COVERAGES CERTIFICATE NUMBER:CL16101902807 REVISION NUMBER:
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.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
A CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 300,000
X BLS 56976078 10/21/2016 10/21/2017 MED EXP (Any one person) $ 15,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000
JECT
$
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY (Per person) $
A
ALL OWNED SCHEDULED BAS 56976078 10/21/2016 10/21/2017 BODILY INJURY (Per accident) $
AUTOS AUTOS X
X HIRED AUTOS x NON-OWNED PROPERTY DAMAGE $
(Per accident)
AUTOS
X Underinsured motorist property $
X UMBRELLA LIAB x OCCUR EACH OCCURRENCE $ 3,000,000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $
X ESO 56976078 10/1/2016 10/21/2017
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY Y / N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E.L. EACH ACCIDENT $ 1,000,000
B OFFICER/MEMBER EXCLUDED? 7690000196161 4/1/2016 4/1/2017 E.L. DISEASE - EA EMPLOYEE $ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
C Commercial Property BKS 56976078 11/10/2016 10/21/2017 $448,000 Value $1000 Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder and their employees are listed as Additional Insured as per CG 88 10 01 10.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
John Wayne Construction, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The Quarter Condominiums ACCORDANCE WITH THE POLICY PROVISIONS.
6605 N. 93rd Ave
Glendale, AZ 85305 AUTHORIZED REPRESENTATIVE

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