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<br />4 <br /> <br />AC.O.BQ. <br /> <br />pftO~I~ (916)443-0200 FAX (916)443-0251 <br />owen' Dunn Insurance Services . . <br />L icens8 NUIDer': 0670.161 <br />2831 G Street Suite 200 <br />-:"""'cramentD, CA 95816-3721 <br />'<..c!f) operat ve Personnel e ces <br />241 Lathrop Way <br />I <br />Slcramen~o CA 95815 <br /> <br />CERTIFICATE OF LIABILITY INSURANCE ~ii:;) <br />THIS CERTFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY-AND CONFERS NO RIGHTS UPÖNTHECERTFICATE. ... <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR <br />ALTER TH C V ORDE BY THE POLICIES <br /> <br />INSURERS AFFORDING COVERAGE <br />~~Rk TRAVELERS <br />INSURER B: <br />INSURER c: <br />INSURER 0: <br /> <br />NAIe . <br /> <br />INSURER E: <br /> <br /> , ' <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN <br />AN'( REQUIREMENT. TERM OR CONJITION OF ANY CONTRACT OR OTHE~ 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 />- TYJOI OF INSIJIIt.I,NCE : POLICY NUMMR POUCY EFFECTIVE POLICY EXPI ATION UMITS <br /> GENERAL LIAIIIL.ITY I 6607704A197 07/01/2004 07/01/2005 ~ OCCURRENCE $ 1,000, <br /> ~ COMMERCIAL GENERAl. UA8ILITY DAMf\GE TO RENTED S 500.1 <br /> ~ :J ClAIMS WADE rn OCCUR I MEO ÐlP (AnyOl18 ØtI'8<1n) S 10, <br />A X I PERSONAl. & M:N INJURY $ Exc1 u£ <br /> I GEN!ML AGGREGATE S 2 000.[ <br /> . GEN'l AGGRtGA1'E LWIT APP1JES PER: I I'ROOUc;TS'. co...op AGO' s 2.000.0 <br /> I POI.ICY n ~R8i n LOC i <br /> ~TOMOBlLI LIABILITY 8l07704A197 07/01/2004 07/01/2005 COr.ABINED SINGLe LI...IT <br /> S <br /> NffAUTO (Ea IOtId8nt) 1.000.00Di <br /> - <br /> - AU. OWNED AUTOS I eoOILY INJURY <br /> $ <br /> SCHEDùLEC AUTOS (Pw pnon) <br />A X - <br /> ~ HIÆD AUTCS . BODILY INJURY ! <br /> i (Per accld8n\) $ <br /> .!. NON-ov.NeD AUTOS , <br /> I PROPERTY DAlMGE $ <br />/.':., , i ("'" 8cc11MnU I <br />,. ~~E LIAIILITY I AUTO OM. Y . EA ~CDENT I : <br /> ANY AUTO' I OTHER THAN I!AACC S <br /> i AUTO OM.Y: ,,00 $ <br /> ijllSlUMlIIIlLLA LIABILITY I EX7704A197 07/01/2004 07/01/2005 EACH OCCURReNCE I 5.0oo,OOQI <br /> X OCCUR 0 CLAIMS w.œ I AGGREGATE $ 5.000,oo~ <br />A X 8 <br /> =i OEDUCna.E ' $ <br /> , <br /> RI!T!NTION S j $ <br /> WOItIlIIU COMPENSATION ANO UB1176A220 07/01/2004 07/01/2005 I X I~~~~I l°.,W' 1 <br /> EMPl..OYERr L...IIUTY 1,000,000 <br />A N(Y PI'IOPRIETORIPARTNER/EXECUTIVE . E.l. EACH ACCIDENT S <br /> DFF1CZRl..,W!!I!fI EXClUœ07 U. DiseASe. I!A EMPLO'fEE 8 1.000.000 <br /> w~~une. <br /> 5 VISIONS belgW E.L DISEASE . POLICY Ur.A1T S 1.000000 <br /> OneR --., <br /> , <br /> i <br /> I i <br /> , : <br />J'.,i'CØTlOf ~ OP~RATIONS I LOC,,! TlONSI VEI'ICLES II!KCLUSIONS ADDED BY !!NOOIlSEMIHT / SPICIAL PROVISIONS <br />e: e.l orn1a Operatlons <br /> ! <br />~nera 1 Liability Additional Insured as per attached endorsement CC D2 48 IO()2 wI priEr)' wording <br />Upon non-payment of premium, 10 day notice of cancellation app1ies. I <br /> , <br /> , <br /> <br /> <br /> <br />City of Santa Ana <br />Attn: Thien-Vu Ngo <br />2Ð Civic Center Plaza <br />Santa Ana, eA 92702 <br /> <br />~OULO ANY OF THE AlOIIE DESCRIBED POUCIIS IE CANC!!LUD 11I'0IUi TNI <br />E~IRATlON DAn THEREOF, T~ ISSUING INBURIR 'MLlUMX~ MAIL <br />30* OAn -TIEN NOTICE TO T~ CUTlI'ICATe HOLD!R NAilED TO THE L£FT, <br />~~ (~øøx~}QiWl~..-x8XX <br />~KIKM.:ftXIHIIJ(XØ¥IIIeOOIIJØXXXXXXXXX <br />MJTHOR~D IUPR~I\ITATM; . Ji1 --- c ;1,....,....t.. <br />~ar anne Novak/LLR <br /> <br />ACORD 25 (2001108) <br /> <br />~ <br /> <br />;/0-- <br /> <br />MCORD CORPORATION 1988 <br />