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9-17-2004 12:07PH FROM JOHN L. RAYA INS. 1 626 281 2972 <br />P. 2 <br />ADD -Ra CERT <br />FICATE OF LIABILITY INSURANCE <br />ATE (MMIDDIYYYY( <br />o9/17/20oa <br />PRODucER (626)570-8611 <br />The John L Raya Insuran <br />401 South Mission Drive <br />P. 0. Box 728 <br />San Gabriel, CA 91778 <br />. FAX (626)281-2972 <br />a Group <br />91776) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC # <br />wwRED Casa de Sa ud Fa <br />1515 5 Broadway <br />Santa Ana, CA 927 <br />y alth C'iniC <br />- <br />INsuRERA: Aden Eagle Insurance Corp <br />INSURER R, <br />INSURER C: <br />POUCY NUMBER <br />INSURER E: " <br />THE POLICIES OF INSURANCE LIS <br />ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI <br />ANY REQUIREMENT, TERM OR CO <br />DITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE 11RANCE A <br />FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />. POLICIES. AGGREGATE LIMITS SH <br />WN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. <br />11198MONTYPE <br />OF INSURANCE <br />POUCY NUMBER <br />PONGYEFFEeT" <br />PDUOYE"PIRAno" <br />Lgyi3 <br />GENERAL LIABILITY <br />60/,9847485 <br />OS/01/2004� <br />05/01/2005 <br />EACH OCCURRENCE $ 1 000, <br />X1 COMMERCIAL GENERAL L <br />41TY <br />DAMAGE TO RENTED $ 105 <br />CLAMS MADE' X <br />OCCUR <br />MED EXP (MY AAs pHaon) $ S, <br />AIT— <br />PERSONAL 6 ADY INJURY $ Incl <br />GENERAL AOGREGATE. $ 2 000 <br />GENL AGGREGATE LIMIT APPt <br />ES PER <br />PRODUCTS • COMP/OP AGO $ 11000.000 <br />POLICY jE <br />LP: <br />AUTOMOBILE <br />LABILITY <br />COMBINED SINGLE LIMIT <br />i <br />ANY AUTO <br />(Eq bemd,,M) <br />BODILY INJURY <br />$ <br />ALL OWNED AUTOS <br />SCHEDVLEDAUTOS <br />(PRT Pq ) <br />BODILY INJURY i <br />HIREO AITTO$ <br />NONOWNEDAUTOS <br />(1,q,Acydenp <br />PROPERTY DAMAGE $ <br />(Ps Avieen0 <br />GARAGE LMmLDY <br />AUTO ONLY - EA ACCIDENT '$ <br />OTHER THAN EAACC '$ <br />ANY AUTO <br />AUTO ONLY. AGG $' <br />EXCESSNMBRELLA LIA&UP <br />EACH OCCURRENCE S <br />OCCUR EICLM <br />3 MADE <br />AGGREGATE $ <br />$ <br />E <br />DEDUCTIBLE - <br />$ <br />RETENTION $ <br />VXWER9 COMPENSATION AND <br />VMC STATU- 0TH- . <br />EMPLOYE" LAMItiY <br />E.L. EACH ACCIDENT E <br />ANY PROPRIETOAVARTNERRDIEC <br />THE <br />E.L. DISEASE -EA EMPLOYE $ <br />OyFeFIICERMIEMBER EXCLUDED? <br />9PECdo <br />IAIP SISI HS DNM <br />EL DISEASE •POLICY LIMIT $ <br />OTHER <br />OF OPERATICNIS/LOCA <br />a City of Santa Ana, <br />1.VEHII��LL��3 l EXCLUSIONS ADDED BY EMORSEMENTI SPECIALPfamim <br />is Otticers, Agents, Employees and Volunteers are named as additional insured <br />s respects their interest <br />in connection with th named insured. Exhibit -B attached <br />evision of certifitat <br />issued 8/27%04 <br />10 days for non-payment <br />of premium <br />SHOULD AHY of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPMTION DATE THEREOF, THE 993UNG INSURER IVILL VAMMM MAIL <br />City of SantaCDBG M-25 30* DAYS'WRIT7EN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />AftCommunity Develo nt Agency 16006WWWQMKX <br />PO Box 1988 M-25 XXXXX <br />Santa Ana, CA 9210Z <br />s <br />ACORD 25(2001IDS) FAX: K714)647-6549 v I V ®ACORD CORPORATION 1988 <br />