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<br />ACORD. CERTIFICA TE OF LIABILITY INSURANCE OP 10 VII DATE (MM/DDIYYYY) <br />MASKS-1 12/09/05 <br />!~f;DUCE~ . THIS CERTiFICATE is ISSUED AS A MATTER OF INFORMATION <br />Andre1n1 & Company-Oxnard ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License 0208825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />300 Esplanade, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Oxnard CA 93030 <br />Phone: 805-981-9585 Fax:805-981-0161 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A Granite State Ins. Co. ."... <br /> INSURER S' ~ <br /> Mask Systems, Inc. INSURER c: ,"", ~ <br /> Rosa Sasa ~.J1'. <br /> 11959 Discove~ Ct. INSURER 0: () <br /> Moorpark CA 93 21 <br /> INSURER E: .. <br /> ,. <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 LJ:l <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IfoJITH RESPECT TO VvrlICH THIS CERTIFICATE MAY BE ISSUED OR C:.:') <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 0,:'-"," <br />POLICIES, AGGREGATE LIMITS SHOVV'N MAY HAVE BEEN REDUCED BY PAID CLAIMS .L, <br /> ..H~ <br />LTR NS'R TYPE OF INSURANCE POLICY NUMBER DA~E fMMfJerkf'\E; PiSkT'f (~~fh'b/''''(~lN LIMITS :;,,;.t <br /> GENERAL LIABILITY EACH OCCURRENCE $ c:~ <br /> I-- PREMISES '(E'~'(;~~~nce) <br /> COMMERCIAL GENERAL LIABILITY $ <br /> I CLAIMS MADE D OCCUR MED EXP (Anyone person) $ <br /> PERSONAL & ADV INJURY $ <br /> I-- <br /> GENERAL AGGREGATE $ <br /> I-- -- <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ <br /> n nPRO n <br /> POLICY JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ,- (Eaaccident) $ <br /> ANY AUTO <br /> - <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEOULED AUTOS (Per person) <br /> -- <br /> HIRED AUTOS BODILY INJURY <br /> -- $ <br /> NON-OVVNED AUTOS (Per accident) <br /> - <br /> - PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ~ ANY AUTO VO.l d__ OTHER THAN EA ACe $ <br /> / ---)J'~, -- AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY , / EACH OCCURRENCE $ <br /> P OCCUR D CLAIMS MADE AGGREGATE $ <br /> $ <br /> R DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND X I TORY LIMITS I I~ER- <br />A EMPLOYERS' LIABILITY 9516480 12/18/05 12/18/06 $ 1000000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? EL. DISEASE + EA EMPLOYEE $ 1000000 <br /> If yes, describe under $ 1000000 <br /> SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT <br /> OTHER <br />DESCRIPTION OF OPERATIONS { LOCATIONS / VEHICLES / EXCL.USIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS <br />Proof of Insurance <br /> <br />CERTIFICATE HOLDER <br /> <br />City of Santa Ana <br />60 Civic Center Plaza <br />Santa Ana CA 92703 <br /> <br />CANCELLATION <br />SHOUL.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WIL.L. ENDEAVOR TO MAIL. ~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT, BUT FAILURE TO DO SO SHAL.L. <br />IMPOSE NO OBL.IGATION OR L.IABILlTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUT 0 ZEDREW~ATIVE <br />'..It-f./ .AQ.-tvf<.4-.> <br /> <br />ACORD 25 (2001/08) <br /> <br />@ACORD CORPORATION 1988 <br /> <br />