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AMA-0- CERTIFICATE OF LIABILITY INSURANCE OP ID °ATB,MM 4/on, <br />NAxot4- os 1a os <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />I90 International. Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />204 Cedar Street, P.O. Sox 716 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Cambridge ND 21613 <br />Phone :410 -225 -6464 Fa::410- 228 -7645 INSURERS AFFORDING COVERAGE NAIC# <br />Nakoma Groug( LLC <br />7777 Center Ave, #690 <br />Huntington Beach CA 926478 <br />INSURER D' <br />Co <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 155UEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CON bITION OF ANY CONTRACT OR OTHER DOCU MEW 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 />P°LJCYNUMSER <br />POLICY <br />GATE MMB)DIYY <br />FVL19Y <br />DATE NM U/YY <br />LASTS <br />A <br />_urn Shti -edy <br />GENERAL LIABILITY <br />X COMMERCULL GENERAL LIABILITY <br />CLAIMS MADE Q OCCUR <br />VP04601509 <br />05/01/03 <br />05/01/04 <br />FACN OCCURRENCE <br />5 1 , O 000 <br />RENIED <br />PREMISE$ :5e Um <br />5250,000 <br />MED EXP(Any one Per9w) <br />$10 000 <br />PERSONAL d Ai INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER <br />X POLICY JGR& LOC <br />PRObUCT9- COMP /OP AGO <br />52,000,000 <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANYAUTD <br />ALLOWNEDAUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON-OWNED AUTOS <br />V11046111509 <br />05101103 li <br />05101/04 <br />COMBINED SINGLE LIMB <br />(Us e IdGM) <br />11,000,000 <br />BODILY INJURY <br />eaen <br />(P&Pl <br />$ <br />BODILY INJURY <br />(Per eccldenU <br />S <br />X <br />PROPERTY DAMAGE <br />lPCracclmnp <br />S <br />GARAGE LIABILITY <br />ANY AUTO <br />AUTO ONLY. EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />AUTOONLY; AGG <br />S <br />S <br />EXCEMM13RELLA UABIUTY <br />OCCUR p CLAIMS MADE <br />DEDUCTIBLE <br />RETENTION I <br />EACH OCCURRENCE <br />5 <br />AGGREGATE <br />S <br />5 <br />S <br />S <br />B <br />WORKERS COMPENSATION AND <br />EMPLOYERS'IIABILRY <br />ANY <br />OFFICER/MIF.TQR E)RTNE D ECUTIVE <br />E e9, deacnbe unAer <br />6 ECUIL PROVISIONS below <br />WC5479413 <br />05101103 <br />05/01/04 <br />X TORY LIMITS I ER <br />E 6 EACH ACCIDENT <br />51 000 000 <br />E.L. DISEASE•EA EM PLOYEE <br />$1,000 000 <br />E.L. DISEASE - POLICY LIMIT <br />51,000 000 <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS <br />City of Santa Ana its officers, agents and employees are named as additional <br />insured per attached additional insured endorsement. SO day notice should <br />policy Cancel for non payment. We are not carrier for Workers Compensation <br />coverages. <br />CERTIFICATE HOLDER CANCELLATION <br />CITYSNT <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Santa Ana,lta O£f CL@ a <br />Agents k EDIp1Oy00�PtTuv7Lb AS TO }" <br />Information Svcs Div 2 <br />"r TO THE ISSUING INSURER WILL CiDdRCRIOMAIL 30 DAYS WRITTEN <br />NB r TO THE CERTIFICATE HOLDER NAMED TO THE LEFT ,BMgiSEBRCW9EP9B9BA[C <br />' <br />P.O. Box 1988 <br />Santa Ana CA 9270 <br />RGPReBeHWeIYS' <br />R P E <br />d� <br />_urn Shti -edy <br />ACORD 25 (2001!08) <br />eel -d CO /20'd 898 -1 <br />V AUUKU UUKHVKA I WIN TSDB <br />98001ZZ011? 1VN011YN831N1 W -sOJd Be09:11 BO- Y1 -Refl <br />