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<br />ACORQM CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) <br />03/02/2005 <br />PRODUCER (949)263-0606 FAX (949)263-0906 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Complete Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />California 001 #0437762 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />19000 MacArthur Blvd., PH Flr <br />Irvine, CA 92612-1447 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Fireman's Fund Insurance Co <br />Caribou Industries INSURER B: <br />Eastcom Corporation INSURER C: <br />1200 North Main Street, Suite 900 INSURER D' <br />Santa Ana, CA 92701 INSURER E: <br /> <br />COVERAGES <br /> <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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY MZX80826694 04/14/2004 04/14/2005 EACH OCCURRENCE $ 1,000,00 <br /> "X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000,00 <br /> ~ CLAIMS MADE m OCCUR MED EXP (Anyone person) $ 10,00 <br /> t-- <br />A PERSONAL & ADV INJURY $ l,OOO,OOCl <br /> t-- -- <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 <br /> m .nPRO- nLOC <br /> POLICY JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> f-- (Ea accident) $ <br /> ANY AUTO <br /> f-- <br /> ALL OWNED AUTOS BODILY INJURY <br /> f-- (Per person) $ <br /> SCHEDULED AUTOS <br /> f-- <br /> HIRED AUTOS BODILY INJURY <br /> f-- $ <br /> NON-OWNED AUTOS (Per accident) <br /> - <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ~ ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY APPROVl: D AS TO -OlU,'l EACH OCCURRENCE $ <br /> :=J OCCUR o CLAIMS MADE AGGREGATE $ <br /> fj ~/7i!-li{i JI; $ <br /> ~ DEDUCTIBLE --. $ <br /> - a Stitt}hccdy <br /> RETENTION $ Lau $ <br /> WORKERS COMPENSATION AND ASSist< nl CITY .''> r ,"rr ;'\ I T~~3T~I.~~ I IOJ~- <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ <br /> OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS beiow E.L DISEASE - POLICY LIMIT $ <br /> OTHER <br />~ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />e: License agreement at 100 South Main Street, Santa Ana, CA <br />~he certificate holder is included as an additional insured as respects general liability coverage and <br />per the attached "Exhibit C" additional insured endorsement. <br />"10 day notice of cancellation for non-payment of premium. <br /> <br />CERTIFICATE H LDER <br /> <br />City of Santa Ana; its officers, employees, <br />agents, volunteers and representatives <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br /> <br />CANCELLA TI N <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 /> <br />ACORD 25 (2001108) <br /> <br />