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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY) <br />TIO 1 02/26/2004 <br />PRODUCER (714)836-994S FAX (714)836-9946 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />The Empire Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />mP mP HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />555 Parkcenter Drive, Ste 206 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Santa Ana, CA 92705-3521 <br />Emily Fisher _ r, I V ED INSURERS AFFORDING COVERAGE NAIC# <br />••�_••-_ wxnow �Pavawn w-vuP, L tlINSONS"E <br />217 North Main Street goo4 NSURER BSuite 300 IL�NSURERCSanta Ana, CA 92701 �����RERE: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MMIDDNYT <br />POLICY EXPIRATION <br />DATE (MMIDD"I <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE Ifl OCCUR <br />72SBAAD9365 <br />02/12/2004 <br />02/12/2005 <br />EACHOCCURRENCE <br />$ 1,000,00 <br />PREMISES Edoccurends) <br />$ 300,00 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL BADVINJURY <br />$ 1,000,00 <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE —LIMIT APPLIES PER: <br />POLICY PRO - <br />LOG <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,00 <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />72SBAAD9396 <br />02/12/2004 <br />02/12/2005 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />1,000,00 <br />BODILY INJURY <br />(Per person) <br />$ <br />X <br />BODILY INJURY <br />(Per accident) <br />$ <br />J( <br />PROPERTY DAMAGE <br />(Per socident) <br />$ <br />GARAGE LIABILITY <br />ANY AUTO <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />AUTO ONLY: AGG <br />S <br />S <br />EXCESS/UMBRELLA LIABILITY <br />OCCUR ❑ CLAIMS MADE.(/ <br />DEDUCTIBLE <br />RETENTION $ <br />- <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />S <br />$ <br />$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMSER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />TORV LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E. L. DISEASE -POLICY LIMIT <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />ity of Santa Ana, its officers, agents, employees, volunteers and representatives are <br />amed as additional insureds. <br />•10 day notice of cancellation shall apply for non-payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />City of Santa Ana <br />*30 <br />Planning and Building Agency <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Ross Annex <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />20 Civic Center Plaza M-20 <br />OF ANY KIND UPON THE IN4UR ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENT <br />Santa Ana, CA 92701 <br />ACORD 25 (2001/08) <br />©,/CORD CORPORATION 1988 <br />,. <br />