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<br />~lW". CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) <br /> 12/15/2004 <br />PRODUCER (520)571-1900 FAX (520)571-9667 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Koty-leavitt Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR <br />6992 E. Broadway Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Tucson, AZ 85710-2803 <br /> INSURERS AFFORDING COVERAGE NAIC# <br />INSURED Card Metered Systems Inc INSURER A: ACE American Insurance Company <br /> DBA: CMS dba INSURER B: <br /> 1104 N Anita Ave INSURER c: <br /> Tucson, AZ 85705-7518 INSURER D: <br /> INSURER E: <br />COVFRA¡;E'" <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD' TYPE OF INSURANCE POLICY NUMBER PR...L.~S~ EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL. LIABILITY EACH OCCURRENCE $ <br /> r- DAMAGE 19r:;~ENTED .,,\ <br /> COMMERCIAL GENERAL LIABILITY $ <br /> I CLAIMS MADE D OCCUR MED EXP (Anyone person) $ <br /> PERSONAL & ADV INJURY $ <br /> r- <br /> GENERAL AGGREGATE $ <br /> r- <br /> GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $ <br /> h ,n:RO- n, <br /> POLICY JECT lOC <br /> ~TOMOBILE UABILITY COMBINED SINGLE LIMIT . <br /> ANY AUTO (Eaaccident) <br /> r- <br /> ALL OWNED AUTOS BODILY INJURY <br /> r- $ <br /> SCHEDULED AUTOS (Per person) <br /> f- <br /> HIRED AUTOS BODILY INJURY <br /> r- . <br /> NON-OWNED AUTOS (Per accident) <br /> r- <br /> f-- PROPERTY DAMAGE $ <br /> (Peracddent) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> R ANY AUTO -/8:3 II 2 OTHER THAN EAACC ' <br /> "-- AUTO ONLY: AGG $ <br /> , <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> 0 OCCUR D CLAIMS MADE AGGREGATE $ <br /> $ <br /> R ~EDUCTrBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND I T'X~~T~,Ir¥s I 10J~- <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETORfPARTNERfEXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFlr.ERfMEMBER EXCUJDED? E.L. DISEASE - EA EMPLOYE . <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> p~THr. CRl139400 04/28/2004 04/28/2005 $1,000,000 Wrongful Act <br /> ro ess;onal Liabil ity <br />A $1,000,000 Aggregate <br /> $10,000 Retention <br />l...ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS attached. <br />certificate holder is named as Additional Insured per form PF8X31c (10/99) <br />This certificate is subject to all policy terms, conditions, exclusions, forms & endorsements <br /> <br />City of Santa Ana <br />Attn: Clerk of the City <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br /> <br />Counci 1 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />D REPRESENTATIVE <br /> <br /> <br />@ACORD CORPORATION 1988 <br />