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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) <br /> TM. i 10/21/2005 <br />PRODUCER PhOlle:(949}453-1115 Fax: 949-453-1244 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ALLIED BROKERS\ YEARGIN INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />15375 BARRANCA PARKWAY, #C-l02 ~~;~;~~~~IS CERTIFICATE DOES ~.?~.~.,M!!'I~;"I~T~~~ n~R <br />IRVINE CA 92618 <br /> ____ Agency Uc#: Q;3.1.5093 INSURERS AFFORDING COVERAGE NAIC# <br /> HARTFORD CASUALTY INS CO - .- <br />INSURED N~aiXJ4-/4-3 INSURER A: <br /> - <br /> INSURER B EMPLOYERS COMPENSATION INS <br />PARADIGM IMAGING GROUP INC .- w_ <br />1590 METRO DR #116 INSURER c' <br /> -- -~ <br />COST A MESA CA 92626- INSURER D" -_.-- <br /> ,-..--- <br /> INSURER E: <br /> <br />COVERAGES <br />THE POLICIES OF INSURol.NCE 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 SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br /> -- .- , .- <br />INSRADD'- TYPE OF INSURANCE POL.ICY NUMBER POLICY EFFECTIVE P~~EY,~~=~N LIMITS <br />LTRINSR DATE MM/1)DIYY <br /> ~NERAL. LIABILITY i 72SBAAB2623 11/20/05 11/20/06 EACH OCCURRENCE I 1,000,000 <br /> DAMAGE "TO RENTED <br /> -" COMMERCIAL GENERAL LIABILITY ~-.LEaOE"Ufencal I 300,000 <br /> - ~~:] CLAIMS MADE [!] OCCUR MED. EXP (Anyone person) I 10,000. <br />A PERSONAL. & ADV INJURY ;$ 1,000,000 <br /> -- -- -- <br /> 'GENERAL AGGREGATE I 2,000,000 <br /> -~ --- ..- I-PRoD~Crs-coMPIOP AGG <br /> GEN'L AGGREGATE LIMIT APPLIES PER 'I 2,000,000 <br /> xl POLICY --I ~~T --1 LOC ,-- n <br /> ~OMOBILE L.IABIL.ITY 72SBAAB2623 11/20/05 11/20/06 COMBINED SINGLE LIMIT <br /> ANY AUTO (Eaaccident) I <br /> - <br /> ALLOWNEDAUTOS BODILY INJURY <br /> - (Per person) I 0 <br /> SCHEDULED AUTOS <br />A ----~-- <br /> X HIRED AUTOS BODILY INJURY <br /> X NON-OWNED AUTOS (Per accident) $ 1,000,000 <br /> I -i <br /> - PROPERTY DAMAGE I 0 <br /> (Per aoodent) <br /> GARAGE LIABILITY i ~!lTO ONLY" EA ACCIDENT $ <br /> =-1 ANY AUTO -- <br /> OTHER THAN EAACCI$ - - <br /> , AUTO ONLY: <br /> , AGG$ <br /> ~CESS I UMBRELLA LIABILITY I _~_~_C_H Oo::URRENCE I <br /> --- <br /> __ OCCUR 0 CLAIMS MADE ! AGGREGATE I <br /> - I <br /> DEDUCTIBLE I <br /> - RETENTION $ ~ -.- <br /> I <br /> I~STATU-I IOTHER <br /> WORKERS COMPENSATION AND SA811 00524332 10101/05 10/01/06 X TORY LIMITS. <br /> 'EMPLOYERS' LIABILITY <br /> ANYPROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT ,I . _1,000,000 <br />B <br /> OFFICERlMEMBEREXCLUOED? E.L. DISEASE-EA EMPLOYEE I l,~O~ <br /> lryes, describe under :E~:-D--;-SEASE-POLlCY LIMIT <br /> SPECIAL PROVISIONS below $ 1,000,000 <br /> OTHER: I <br /> <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />10 DAY NOTICE OF CANCELLATION FOR NON PAYMENT. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER ATTACHED FORM <br />550080401 FOR GENERAL LIABILITY ONLY. 0 FORM <br />APPROVED AS T <br /> <br />- /({M_'. ,IJt'I./A'.,_. <br />CERTIFICATE HOLDER ~ ~^" CANCELLATION <br />. yjP _ -.$HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Assistant CltY, Attorn ~~PIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN <br />_ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br /> <br />THE CITY OF SANTA ANA <br />PUBLIC WORKS AGENCY M85 <br />220 SOUTH DAISY AVE <br />SANTA ANA, CA 92703 <br /> <br />AUTHORIZED REPRESENT A TIVE <br /> <br />~l ~ L. <br />, ':;:;;..< - ~ <br />MIChael Yeargin <br />@ACORD CORPORATION 1988 <br /> <br />~- c.. <br /> <br />Attention: <br /> <br />ACORD 25 (2001/08) <br /> <br />Certificate # <br /> <br />5538 <br />