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<br />PRODUCER (S20)571-1900
<br />Koty-Leavitt Insurance
<br />6992 E. Broadway Blvd
<br />Tucson, AZ 8S710-2803
<br />
<br />FAX (S20)S71-9667
<br />Agency, Inc.
<br />
<br />DATE (MMIDDIYYYY)
<br />07/01/200S
<br />
<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 />
<br />I
<br />
<br />-. AmBLt
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />INSURED
<br />
<br />Card Metered Systems Inc
<br />DBA: CMS dba
<br />1104 N Anita Ave
<br />Tucson, A2 8S70S-7S18
<br />
<br />t.J - J.1J05 -OtJ I
<br />
<br />INSURERS AFFORDING COVERAGE
<br />INSURER A- Hartford Casualty Insurance
<br />INSURER B:
<br />INSURER c:
<br />INSURER 0:
<br />INSURER E:
<br />
<br />Co
<br />
<br />NAIC#
<br />29424
<br />
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />INSR DO'
<br />
<br />TYPE OF INSURANCE
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />I CLAIMS MADE 0 OCCUR
<br />
<br />POLICY NUMBER
<br />
<br />POLICY EFFECTIVE
<br />
<br />P2~lCY EXPIRATION UMfTS
<br />07/01/2006 EACH OCCURRENCE , 1,000,00C
<br /> DAMAGE TO RENTED , 300 ,OO[
<br /> MED EXP (Anyone person) , 10,000
<br /> PERSONAL & ADV INJURY , 1,000,000
<br /> GENERAL AGGREGATE , 2,000,000
<br /> PRODUCTS. COMP/OP AGG , 2,000,000
<br />
<br />S9SBABX2462 07/01/200S
<br />
<br />A
<br />
<br />-
<br />-
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />---, nPRO- n
<br />I POLICY JECT LOC
<br />AUTOMOBIL.E LIABILITY
<br />~
<br />X ANY AUTO
<br />-'-'--
<br />ALL OWNED AUTOS
<br />-
<br />SCHEDULED AUTOS
<br />-
<br />HIRED AUTOS
<br />
<br />S9UECTM74330 07/01/200S
<br />
<br />.
<br />07/01/2006
<br />
<br />COMBINED SINGLE LIMIT
<br />(Eaaccident)
<br />
<br />,
<br />
<br />1,000,000
<br />
<br />BODILY INJURY
<br />{Per person)
<br />
<br />,
<br />
<br />A
<br />
<br />-
<br />f--
<br />f--
<br />
<br />NON-OWNED AUTOS
<br />
<br />BODILY INJURY
<br />(Peracddent)
<br />
<br />,
<br />
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />
<br />,
<br />
<br />EXCESS/UMBRELLA LIABILITY
<br />~ OCCUR D CLAIMS MADE
<br />
<br />I DEDUCTIBLE
<br />I RETENTION $
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />If yes, desClibe under
<br />SPECIAL PROVISIONS below
<br />OTHER
<br />
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />
<br />,
<br />EA ACC $
<br />,
<br />,
<br />,
<br />,
<br />,
<br />,
<br />
<br />AGG
<br />
<br />~~GE UABIUTY
<br />I ANY AUTO
<br />
<br />AUTO ONLY - EA ACCIDENT
<br />
<br />OTHER THAN
<br />AUTO ONL yo
<br />
<br />.., '"
<br />"1'1'RO'!" ,>
<br />
<br />-f} f o_.~~.
<br />----r...-y. j" ." ---/'-'
<br />
<br />;-\'''''''\
<br />~,t.) l,-),-,l"
<br />t..S .
<br />
<br />--
<br />-
<br />
<br />I.we STATU- IOJb'-
<br />
<br />E.L. EACH ACCIDENT $
<br />E.L DISEASE. EA EMPLOYEE $
<br />E.L DISEASE - POLICY LIMIT $
<br />
<br />, '
<br />
<br />DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS
<br />e: Copy Machines at Santa Ana Public Library
<br />he City of Santa Ana its officers, employees, agents and volunteers are named as Additional Insured
<br />or General Liability.
<br />Statutory non-payment
<br />his certificate is subject to all policy terms, conditions, exclusions, forms & endorsements
<br />
<br />U^,neD
<br />
<br />, 'Tlml
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />30* 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 />OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE ~.
<br />Jeanne Glessner/JG ~ WL. "L'
<br />@ACORDCORPORATION 1988
<br />
<br />City of Santa Ana
<br />Clerk of the City Council
<br />20 Civic Center Plaza eM-30)
<br />Santa Ana, CA 92704
<br />
<br />ACORD 25 (2001/08)
<br />
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