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<br />.ffug ''''1'S 04 02: 1510 <br /> <br />T 11 ac¡; 1 <br /> <br />p. 1 <br /> <br />ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYY¡ <br /> AUG 10 04 <br />, - TM. <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />BACCARJ:LLA INSURANCE SERVICES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />6864 INDIANA AVE. # 201 HOLDER THIS CERTIFICATE DOES NOT AMEND, EXT;~~ OR <br />RIVERSIDE CA 92506 ALTFR'I'UI:!:tv TIoIF ~. <br />PHONE: 877-587-4999 <br />FAX: 866-307-6352 INSURERS AFFORDING COVERAGE NAlC# <br />.- .-' .- <br />INSURED INSURER A: LINCOLN GENERAL INSURANCE COMPANY <br />C.B. GLENN TILE COMPANY, INC. INSURER B: <br />8571 CODY AVE INSURER C: <br />WESTMINSTER CA 92683 <br /> INSURER 0: <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW t1AVE BEEN ISSUEO TO THE INSURED NAMED ABO\Æ FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUREMENT. TERM OR CONDITION OF f>loIY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCE AFFORDFO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAIlE BEEN REDUCED BY PAID CLANS <br /> <br />'NS <br />l <br /> <br />TYPE OF INSURANCE <br />GENERAL LIABILITY <br /> <br />POLICY NUMBER <br />25370074601 <br /> <br /> <br /> LIMITS <br />JAN 23 05 EACH OCCURRENCE S 10,000 <br /> DAMAGE TO REN'ŒD $ _100,000 <br /> P MISES t'E9 occureI'1ce\ <br /> MED. EXP (Any Ol1e Person) $ 5.000. <br /> .- <br /> PERSONAL & MJV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> I'RODUCTS-COMP/OP AGG. $ INCLUDED <br /> COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> BODILY INJURY <br /> (Per pensu,,) $ <br /> BODL Y INJURY S <br /> (Per accident) <br /> PROPERTY DAMAGE $ <br /> <br />X COMMERCIAL GENERAL LIABLITY <br />CLAIMS MADE I~ OCCUR <br /> <br />A <br /> <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br /> <br /> <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br /> <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIREO AUTOS <br /> <br />NON-QWNED AUTOS <br /> <br />EXCESS I UMBERElLA LIASILITY <br />OCCUR 0 CLAIMS MADE <br /> <br /> <br />/4 <br /> <br />AUTO ONLY. EA ACCÐENT $ <br /> <br />OTHER THf>loI EAACC $ <br />AUTO ONLY, ÞI $ <br /> <br />EACH OCCURRENCE S <br /> <br />AGGREGATE $ <br /> <br />$ <br />$ <br /> <br />$ <br /> <br />GARAGE LIABILITY <br />ANY AUTO <br /> <br />-'- <br /> <br />DEDUCTIBLE <br /> <br />RETENTION <br /> <br />s <br /> <br /> <br />onlER <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY <br /> <br />ANY pltOPRlETOlllPARTNERJEXECUnVE <br />OFI'ICEflJMoMBER EXCLUDED? <br />H yes. desCflbe under <br />SPECIAL PROVISIONS below <br /> <br />E.L EACH ACCIDENT $ <br />. EL DISEASE-EA EMPLOYEE $ <br />E.L DISEASE-POLICY lIMIT $ <br /> <br />OTHER: <br /> <br />DESCRIPTION Of OPERATlONS/LOCATlONNEHICLESJEXCLlJSIONS ADDED ENDORSEMENTI SPECIAL PROVISIONS <br />"10 DAY NOTICE FOR NON PAYMENT OR NON REPORTING OF PAYROLL" <br />RE: INSTALUNG TlLE@ 1000 E. SANTA ANA BLVD #108, SANTA ANA, CA92701 <br />CERTlfICATI: HOLDER AND THE CITY OF SANTA ANA, ITS OFFERlCERS, AUTHORIZED AGENTS & EMPLOYEES ARE TO BE NAMED AS <br />ADDITIONAL INSURED ONLY AS THEIR INTERESTS MAY APPEAR PER FORM ATIACHED. <br /> <br /> <br /> <br />ADDITIONAL INSURED; I..SURER LETTER: <br /> <br />c :nON <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF. THE ISSUING CQMPf>loIY WIlU;:tl¡¡¡;"'9R TO MAIL 30' <br />DAYS WRrnEN NOTICE TO THE CERTFICATE HOLDER NAMED TO THE lEFT.- <br />rMl,Jdll[ T8 i¡)Q se GI1.~L 1041788(;: t18 8Bb.I~I@r! 9RLIA.ÐIL~Y9r "LJ¥I~ItH~ b!rø~! "RŒ <br />II86b1RER,1T 8. 8EIJT8 8R RC:P'rxu~:(;j¡;:tt;rATr.~. <br /> <br />AUTHORIZED REPRF.SENTATIVE <br /> <br />ç¡.¿ ~lULd~ <br /> <br />. Attention: <br /> <br />KRISTA (714)379-047.4 <br /> <br />---.,-,,,.-.-- <br />