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Certificate of Insurance <br />1 of 1 #74135 <br />COVERAGES: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />TYPE OF INSURANCE POLICY NUMBER EFF.DATE EXP.DATE <br />GENERAL LIABILITY <br />Agency Name and Address: <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF <br />Professional Practice <br />INFORMATION ONLY AND CONFERS NO RIGHTS UPON <br />Insurance Brokers, Inc. <br />THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES <br />2244 West Coast Highway, Suite 200 <br />NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />Newport Beach, CA 92663 <br />AFFORDED THE POLICIES LISTED BELOW. <br />C. <br />Avmonzw Representative: 03/15/04 <br />Insureds Name and Address: <br />es Affording Policies: <br />Dougherty + Dougherty Architects, LLP <br />AEverest NatiorCompanial <br />3194 D Airport Loop Drive <br />B.C. <br />Costa Mesa, CA 92626 <br />D <br />E. <br />F. <br />Protective <br />COVERAGES: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />TYPE OF INSURANCE POLICY NUMBER EFF.DATE EXP.DATE <br />uescrlpnon Of uperauons/LOCatlons/Vehicles/Hestnctions/Special items: <br />EVIDENCE OF INSURANCE <br />'Written at annrwnatw limits of linhilifv not lees than a,n —+ chn,.rn <br />POLICY LIMITS <br />General Aggregate: <br />Products-Corn/Ops <br />Aggregate: <br />Personal and Adv. Injury: <br />Each Occurrence: <br />Fire Dmg. (any one fire): <br />Combined Single Lima: <br />Bodily Injury/person: <br />Bodily Injury/accident: <br />Property Damage: <br />Each Occurrence: <br />Aggregate: <br />Statutory Limits <br />Each Accident: <br />Disease/Policy Limit: <br />Disease/Employee: <br />Per Claim SI,000,000 <br />Aggregate $1,000,000 <br />$0 <br />GENERAL LIABILITY <br />Certificate Holder: <br />THE AGGREGATE LIMIT IS THE TOTAL INSURANCE AVAILABLE FOR CLAIMS PRESENTED <br />WITHIN THE POLICY FOR ALL OPERATIONS OF THE INSURED. <br />❑ Commercial General Liability <br />CANCELLATION: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING COMPANY, ITS AGENTS OR REPRESENTATIVES WILL MAIL W <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EXCEPT IN <br />Santa Ana, CA 92701 <br />THE EVENT OF CANCELLATION FOR NON-PAYMENT OF PREMIUM IN WHICH CASE 10 DAYS <br />❑ Claims Made <br />C. <br />Avmonzw Representative: 03/15/04 <br />❑ Occurrence <br />❑ Owner's and Contractors <br />Protective <br />El <br />AUTO LIABILITY <br />❑ Any Automobile <br />❑ All Owned Autos <br />❑ Scheduled Autos <br />❑ Hired Autos <br />❑ Nan -owned Autos <br />❑ Garage Liability <br />EXCESS LIABILITY <br />❑ Umbrella Form3 <br />"� <br />11 Other than Umbrella Form <br />WORKERS' <br />- <br />COMPENSATION <br />{ <br />AND EMPLOYER'S <br />LIABILITY <br />Al <br />PROFESSIONAL <br />LIABILITY' <br />48AE002101031 <br />11/27/03 <br />11/27/04 <br />uescrlpnon Of uperauons/LOCatlons/Vehicles/Hestnctions/Special items: <br />EVIDENCE OF INSURANCE <br />'Written at annrwnatw limits of linhilifv not lees than a,n —+ chn,.rn <br />POLICY LIMITS <br />General Aggregate: <br />Products-Corn/Ops <br />Aggregate: <br />Personal and Adv. Injury: <br />Each Occurrence: <br />Fire Dmg. (any one fire): <br />Combined Single Lima: <br />Bodily Injury/person: <br />Bodily Injury/accident: <br />Property Damage: <br />Each Occurrence: <br />Aggregate: <br />Statutory Limits <br />Each Accident: <br />Disease/Policy Limit: <br />Disease/Employee: <br />Per Claim SI,000,000 <br />Aggregate $1,000,000 <br />$0 <br />Certificate Holder: <br />THE AGGREGATE LIMIT IS THE TOTAL INSURANCE AVAILABLE FOR CLAIMS PRESENTED <br />WITHIN THE POLICY FOR ALL OPERATIONS OF THE INSURED. <br />City of Santa Ana <br />20 Civic Center Plaza <br />Ross Annex (M) <br />CANCELLATION: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING COMPANY, ITS AGENTS OR REPRESENTATIVES WILL MAIL W <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EXCEPT IN <br />Santa Ana, CA 92701 <br />THE EVENT OF CANCELLATION FOR NON-PAYMENT OF PREMIUM IN WHICH CASE 10 DAYS <br />NOTICE WILL BE GIVEN. <br />C. <br />Avmonzw Representative: 03/15/04 <br />