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SEP-7-2904 15:25 FRDM:RTRDERO INSURRNCE RG 19093556679 TD: 17146476515 P.3~3 <br />` Policy Number: <br />ACORD <br />CERTIFICATE OF LIABILITY INSURANCE O <br />i2 <br />,~ 9i7 <br />D <br />a <br />vRDDOCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />9835 Sierra Avanua ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Fontana, G 92335 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />(909)355-6677 <br /> INSURERS AFFORDING COVERAGE <br />9730376 046 <br />BJSIXiED CZT, COEQ, INC. INSURERA AIO <br />~.- <br />WILLIAM ROllEBSORG INSURER B' <br /> <br />PO 80R 990513 INSURER G'. <br />TEHECULII, G 92592 INSURER D'. <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I6&UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED XEREIN IS SUBJECT TO ALl THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMBS SHOWN MAV HAVE SEEN REDUCED BY PAID CLAIMS. <br />XifR TYPE OF EA{IRARC! POLICE NIafl[R POLICY EFRCTM PD{JCT E1fIMTgN LJaTS <br /> oElf!RAL MABS.ITY EACH OCCURRENCE S S , GOO, DDD <br />A COMMERCML OENERALLWALRY 170250601 7/23/2004 7/23/2005 PREDAMAGE wr An 550,000 <br /> CWMS MADE ®OCCIR MED EXP one n f S, GGC <br /> PERSONAL BADV INNRV f1, 000, 000 <br /> GENERAL AGGREGATE 51,000,000 <br /> GENT AGGREGATE LIMRAPPLIES PER; PROIXgTS-COMPADP AGO S1, DDD, DDD <br /> PDUa PR ~ Loc <br /> A~ oMOB~ llAetitt COMSRED SRGLE LIMR <br /> ANY AUTO (EA Am~I~ i <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEWLEDAUTOS (Per peroon) f <br /> HRED AUTOS <br /> BODILY INJURY <br />f <br /> NON-0NMEO AUTOS (pyepgOypl <br /> PROPERtt D <br />M <br />E <br /> A <br />AG 5 <br /> (Per aceJtlalt) <br /> GARAGE UABt.ITY AUTO ONLY•EAACCIDENT b <br /> ANY AUTO OTHER THAN EA ACG S <br /> AUTO ONLY; AGO S <br /> EXCESS UAaLITY EACH OCCURRENCE S <br /> OCCUR CWMS MADE AGGREGATE f <br /> f <br /> DEDUCTIBLE S <br /> REIENTgN f 5 <br /> YIORNERS COfPE1JUT10N 4D / <br /> flIPLOYER$'LYBlJ1Y i ~ / <br /> l <br />~ <br />~ EL EACH ACCIDENT f <br /> <br />~ . <br />E.L. DISEASE ~ Ed EMPLOYEE <br />f <br /> / <br /> EL DISFASE•POLICY LIMR f <br /> OTIER <br /> ~_~ <br />OESCRPIgN OF OPPAIRgN81LOCATIDNBMXCIIBRXCL118gN$ ADDED BY ENDORSEI~NTISPSCYIL PRDYggNb <br />THE CERTIFICATE HOLDER, IT9 OFFICERBr EMPLOYEES, AGENTS, VOLONTEERB AND REPREBENTATIVEB ARE <br />NAMED AS ADDITIONAL INBQRED AS RESPECTS TO THE OPERATIONS OF THE NAMED INSURED. <br />TEE CITY OF BANTA ANA <br />20 CIVIC CENTER PLAEA <br />BANTA ANA, G 92701 <br />BMOULD ANY OF THE AaoYC DESpaYED POLMES BB CANCEl1JiD ESOfS THE E%PRATIDN <br />D11TE THEREOF, TIE ISSUNO RSURCR IVLLL lNDeAVOR TD MNL O9 D DAYS WPoTTEN <br />NDTN:E TG 111E CERTIFICATE HOLD@R HAYED ro THe lEF'r, BUT FAY IIN to DO SO fue„ <br />MPDEB No aBLXUTroN oRyr~ AfR qND UPON TIE N9UIER, RS AGENTS OR <br />