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ACORD CERTIFICATE OF LIABILITY INSURANCE iiioizoo <br />PRODUCER (714)905-1923 FAX (714)905-1910 <br />Hayward Tilton & Rol app Ins. Assoc. , Inc. <br />License #0614365 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION` <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDtR. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />P.O. Box 25529 <br />Anaheim, CA 92825-5529 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSUpeD Mullen & Associates, Inc. INSURER A: U. S. Fidelity and Guaranty Co. <br />1200 N. Jefferson Street INSURER 6: National Liability & Fire Compa y <br />Suite D INSURER G: Everest National Insurance Co. <br />Anaheim, CA 92807 INSURER D: <br /> INSURER E: <br />COVERAGES <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />NISR IVPE OF INSURANCE POLICY NUMBER POLICY EFFECTWE POLN:V IX%RATION NMR$ <br /> GENERAL LIABILITY BK02131153 07/24/ZOOS 07/24/2006 EACH OCCURRENCE $ 1,000,00 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300, <br /> CLAIMS MADE ~ OCCUR MED EXP (My one person) $ lO, OO <br />A Deductible- None PERSONALBADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> X POLICY PRD LOC <br />JECT <br /> AU TOMOBILE LIABILRV BK02131153 07/24/2005 07/24/2006 COMBINED SINGLE LIMIT <br /> ANV AUTO (Ea accitlenq $ <br />1,000,00 <br /> ALL OWNED AUTOS OTE: THIS COVERAGE IS BODILY INJURY <br /> <br />A SCHEDULED AUTOS FOR NON-OWNED & HIRED tPer Pars°nl $ <br /> X HIREDnuros UTO COVERAGE ONLY- NO <br /> eoDKV IwuRY $ <br /> X NoN-owNED AUros OWNED VEHICLES. (Per a°Gtleml <br /> X Deductible-None <br />PROPERLY DAMAGE <br /> <br />(Per amtleny $ <br /> GARAGE LIABILT' AUTO ONLY-EA ACCIDENT $ <br /> ANV AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY. AGG $ <br /> IXCESSNMBRELLA LVIBILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS CDMPENSATION AND 0100004443 051 02/04/2005 02/04/2006 X WC sTATU- oTH- <br /> <br />B EMPLOVERS' LIABILRV <br />ANY PROPRtETOR <br />PARTNEP/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br /> : <br />OFFICERtMEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYE $ 1,000,000 <br /> If yes, tleamibe untler <br />SPECIAL PROVISIONS below <br />E.L. DISEASE-POLICY LIMIT <br />$ 1,000,000 <br /> DTN <br />~ <br />i <br />l <br />i <br />bili 48AE0006050s1 01/04/2005 01/04/2006 $1,000,000 Each claim <br /> ro <br />ess <br />ona <br />L <br />a <br />ty <br />C $1,000,000 Aggregate <br /> $10,000 dedutible <br />DESCRIPT DFO ERATI /EOCA S/Y CLES F,](CWSI $AODED BV ENDONS TJSPECWL PROVL41QN5 <br />E <br />~" <br />a~ <br />e: Al wor per orme or t e <br />Tty o <br />Santa Ana- P <br />cs, RecreatTOn & Community Services Agency <br />y the named insured. <br />ertificate holder is added as additional insured as per Add'1 Insured Endt. CL/BF22681004 attached. <br />Note:Ten Day Notice of Cancellation for Non-Payment of Premium/Non-Submission of Payroll Report. <br />r:FQTIPIr:ATF H(TI ^FR CBNf:FI I BTIfTM <br /> SHOULp ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFONE THE <br /> <br />City of Santa Ana IXPIpAT10N DATE THEREOF, THE ISSUING INSUREp WILL WXXI~X~X'~HL MAIL <br /> <br />Parks, Recreation & Community Services Agency °30 GAYS WRRTEN NOTICE TO THECERTIFlCATE HOLDEp NAMED TO THE LEFT. <br /> <br />Attn: Carla Thompkins ifJD4X1(ifdtXd6Xi(X7D(diYeX3OE1fXJ{MYIG4if3P~O0HWCAEX~JUfXX: <br />P.O. Box 1988 M-23 APPROVED AS ~T ai16X11(d4Xil#IJIilE1iN~W,(IYd(XdE74XI~'DNHOId(dEYi5XlSYdkXXXXXXXXX: <br />Santa Ana, CA 92702 AUTHORIZED pEPRESENTATIVE (1 <br />tiVl~~ (7 <br /> Dona Deli ht/DLD <br />ACORD 25 (2001/08) FAX: (714) 571-4299 ~-y.--~==~,T ©ACORD CORPORATION 1998 <br />Laura Stilt edy <br />Assistant Gi Attorney <br />