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Ite: 9/7/2005 Time: 11:34 AM To: ~ 96476515 <br />714-905-1910 Paqu: 003-006 <br />ACORQ CERTIFICATE OF LIABILITY INSURANCE o9io %zoos <br />PRODUCER (714)905-1923 FAX (714)905-1910 THIS CERTI FICATE IS ISSUED AS A MATTER OFINFORMATION <br />Hayward Tilton & Rol app Ins. Assoc., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />License N0614365 ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. <br />P.O. Box 25529 <br />Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED Cycom Data Systems, Inc. ncUaeRA Hartford Casualty Insurance Co 29424 <br />6835 Roberta Rd. SW INSLRBRR Continental Casualty <br />Ocean Isle Beach, SC 28469 IvsIIReRr <br /> Ir'.l l,i[R 17 <br /> Vd9.RFF t <br />R ES <br />COV AG <br />THE POLICIES OF INSURANCE LISTED BELOVY HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07WITH STANDING <br />TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCU MENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />ANY REOU IR EMENT <br />, <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED H EREIN IS SU BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR OD' TYPE OF INSURANCE POLICY NLMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILRY 72SBANJ1649DX 06/04/2005 06/04/2006 eArH T~z~.uRRENSe ~ 1,000,000 <br /> X TOtdMEPCIAL SHJEHAL LI NPDILITY DAMAGE TO RENTED g 300 SOD <br /> ~__AIME MADE ~uT~'UR MED E*P (ATy ~,nE peuun S 10, DDD <br />A vBRSONALa ADV IrlduRr a 1,000,000 <br /> tiEIJERAL AGGREGATE $ 2, DDD, ~~~ <br /> SCN'L AGGREG=ATE Li MIT APPLIE>PER PP.OCUGT_ !~IMP~TP AI'-6 S 2, ODD, DOO <br /> F'RG <br />PCLL'f JECT Ln~_ <br /> AUT OMOBILE LIABILITY V MBI NLD S VDLE LIMIT <br />5 <br /> (Ea acs deny <br /> AN'i AIIT <br /> AC- OWNCD AUTT'= EDGILY Vu.IURv <br />t <br /> - IPer pemanl <br /> vrIILDUI FU AJLOS <br /> HIRFD AUTO ti Eau DIL NJUR'Y $ <br /> (Pvr ac.~.lenq <br /> NON NVNcD PI IP r.- <br /> PROPERTY L`AMA,;E £ <br /> IFe' ecv]Rnq <br /> GARAGE LIABILRV AUT! ~ ONLY ~ EA AT CIDENT 5 <br /> AIJ'! AUT!' uTl ICP'HAN EP AO- $ <br /> NUT!~pNL" Pf.G $ <br /> E%CESSIUMBRELLA LIABILRY FA~_H ~~TT,RRtT1GE 8 <br /> ~w~UR ~ CLAIMS MADE AGGREGATE V <br /> S <br /> DEDUCTINLE $ _ <br /> RETEfJTIOIJ $ ~ <br /> WC 9TPTU- OTH- <br /> WORKERS COMPENSATION AND TTRY I I <br /> EMPLOYERS' LIABILRY <br /> <br />I <br />TN <br />E <br />T <br />E <br />T <br />EL EACH A'J-1DEN- <br />$ <br /> ERIEA <br />AIJY RFOPRIET~ <br />R/RAR <br />C <br />J <br />IV <br />~,EHGTH/MEMHiHrx(;UID6["I tL DISEASE EA EMPLOYE R <br /> If yes, tlas~.'Ibx unJer <br />3FEJAL PROVSIONS belrnrv <br />t I DISi ASG POLICE I IMIT <br />$ <br /> l Li <br />bili <br />o~` 267898038 07/16/2005 07/16/2006 $1,000,000 Aggr. Incl Expenses <br /> essiona <br />a <br />ty <br />r f <br />l A <br />h <br />B Wrong <br />ct <br />E1, 000, 000 Eac <br />u <br /> Y10,000 Deductible <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMEM I SPECIAL PROVISIONS <br />ertificate holder is named as additional insured as respects to general liability but only as respects <br />o services provided by the named insured. <br /> <br />~ <br />'~~ ~// <br />=CANCELLATION: 10-day notice for non-payment of premium. <br />- <br />. -- r.._-<_... <br />._...----_. <br />CFRTFII`ATF UnI nFR CANCELLATION ~ ' <br /> SHOLLD ANV OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE <br /> E%FMiAT10N DATE THEREOF, THE ISSUING INSURER W ILL ENDEAVOR TO MAIL <br />Clty of Santa Ana 3O" DgYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />Office of the City Attorney <br />Attn: 7uanita Hernandez BIfT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATON OR LIABILITY <br />2D Cl V1C Center Plaza OF qNY KIND UPONTHE INSURER, rtS AGErQ3OR REPRESENTATIVES. <br />Santa Ana, CA 92701 Al1THORIZEO REPRESENTATVE ~~,~ q- <br />~ <br />~ <br />~j <br /> Valerie Gallardo MG (J <br />'° <br />' <br />-_ <br />ACORD 25 (2001109) FAX: (714)647-6515 oOACORD CORPORATION 1989 <br />