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10/14/2005 10:09:41 AM <br />10 It <br />Sara Coutee <br />Page 3 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE OPID SA MTEIMMNDYYYY) <br />FAZEFC-1 10 14 05 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />G. S. Levine Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />10505 Sorrento Valley Rd. #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />San Diego CA 92121 <br />Phone: 858-481-8692 Fax: 858-481-7953 INSURERS AFFORDING COVERAGE NAIL # <br />INSURED 113'PER A Fidelity and Guaranty Ina. Co. <br />TL.PERB St. Paul F¢re And Marine In• <br />Scott Fazekas 6 Associates TO 31FIR, <br />9 Corporate Park S-200 u+,uRERG <br />Irvine CA 92714 -- - <br />IN.,uREP E <br />rnvcanr.Ps <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 />RISR POLICY EFFECTIVE POLICY EXPIRATION <br />LTR N6R0 TYPE OF INSURANCEPOLICY NUMBER DATE MM�OOVYY DATE MMI00/YT LIMITS <br />CENERaL LIABILITY <br />111 AIIIIF $1,000,000 <br />A <br />�X '- I IOMEPLIAu. EMA4ALLIABIUT� <br />BKO1777291 <br />06/05/05 <br />06/05/06 <br />P EMI ETIE LrenLe $ 300,000 <br />IT AIM, MPI]E [Xj III <br />MtL11PIPMUIRpFi70nl 110,000 <br />PEI­,LNAI . ADEINTIRY $1, 000, 000 <br />— <br />�$2, <br />L.ENFRAL. 1111FFIATE 000, 000 <br />GEN'LHGGUE-PTE LIMIT APPLES PER <br />PRUDI If T', II "Af 11 aCO 12, 000,000 <br />Ben. <br />1,000,000 <br />P-ULL TE T wL <br />AUTOMOBILE. <br />LUMMUTY <br />_ <br />M]INLiI'oINL�Lt IJMII <br />$1, 000 000 <br />A <br />AM-ADTL, <br />BK01777291 <br />06/05/05 <br />06/05/06 <br />tE°"TIoeIIn <br />E <br />IPYr PPr-,om <br />ALL uwvm A I H H <br />dlntuctm Am I In. <br />X <br />'WED AUTTI <br />�X <br />VBN.uWNED AST05 <br />lPere¢menll <br />$ <br />j <br />r <br />FI YDAMAGE <br />IPOILLOILP <br />DAMAGE LIABILITY <br />nnT (ONLY -EAAI LOENT 4 <br />I <br />ANr ALIT4 <br />L_ <br />EA AI r $ <br />iTTHEP TIAI _ <br />AJT'I ONLY All <br />EXCESSNMBRELIA LIABILITY <br />EA, TI CI)POFNCE <br />,,,PEGA-E $ <br />JELVF JLA-1 1E <br />$ <br />nrtTrTIIr <br />$ <br />RETFNTIpN $ <br />I $ <br />WORKERSCOMPEISATIONAND <br />Wf Sle-u, IIIH- <br />X Ti �R'i LIMIT'.. :k <br />B <br />EMPLOYERST,jKlILIABILITY <br />BW02092909 <br />06/05/05 <br />06/05/06 <br />$ 1000000 <br />EL EAa+a�aoervT <br />PMi fy? C'+RICTOREo :T NE <br />EL OIBEA'nE-E4 FMM1UIVEE <br />_ <br />L 1000000 <br />LI E(I'EL <br />I,, GR/MEMflFR E+'CUIDE9P <br />ITVry Imne/ <br />EL OISEADE POLO 11Mll <br />i¢1DDDOOD <br />ALP' I <br />o�L: P,LPcpNSIriVG Delow <br />OTHER <br />DESCRIPTION OF OPERATIONS 'LOCATIONS /VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS %, r :SI a L'D S `J 1 ORM <br />Re: All Operations of the Named Insured <br />Proof of Insurance <br />*10 day notice of cancellation applies for non-payment of premium. XX <br />~lift 5Le dy <br />S.l L111t Willy Altorn31' <br />CERTIFICATE HOLDER CANCELLATION <br />CITSAN2 <br />SHOULD ANY OF THE MOW DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Santa Ana <br />DATE THEREOF, THE ISSUING INSURER WIL ME 30* DAYBWRITTEN <br />Planning S Building Agency <br />20 Civic Center Plaza (M-20) <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFIaWB�eEB�BEEYYr <br />PO Box 1988 <br />Santa Ana CA 92702 <br />Aw^swleweer <br />P IlED REPRESENTATIV <br />ACORU 25 (2001/08) 1 © ACORD CORPORATION 1988 <br />