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<br /> A CORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIOOIYV)
<br /> 01/13/06
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br /> MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> SUITE 400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br /> 1255 23RD STREET, NW, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
<br /> WASHINGTON, DC 20037 COMPANIES AFFORDING COVERAGE
<br /> Alln: SHARON HENNING 202 263 7600
<br /> COMPANY
<br />500625.0P ROF-ON L Y- A FEDERAL INSURANCE CO
<br />INSURED I COMPANY
<br /> MAXIM US, INC, AND ALL SUBSIDIARIES B TWIN CITY FIRE INSURANCE COMPANY
<br /> 11419 SUNSET HILLS ROAD
<br /> RESTON, VA 20190 COMPANY
<br /> II C AMERICAN INTERNATIONAL SPECIALTY LINES
<br /> COMPANY
<br /> 0 HARTFORD INSURANCE CO, OF THE MIDWEST
<br />COVERAGES this certificate supersedes and replaces any previously Issued certificate. 1
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGAlE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />CO TYPE OF INSURANCE POL.ICY NUMBER POL.ICY EFFECTIVE POL.ICY EXPIRATION L.IMITS
<br />LTR DATE IMMIDDIYY) DATE (MMIDDIYY)
<br /> GENERAL LIABILITY GENERAL AGGREGATE 1$ 2,000,000
<br />A Ft2'MERCIAL GENERAL LIABILITY 3537-42-97 105/01/05 05/01/06 PRODUCTS - COMP/OP AGG 'I $ 2,000,000
<br /> CLAIMS MADE ~ OCCUR I I PERSONAL & ADV INJURY $ 1,000,000
<br /> H (IN NER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
<br /> I FIRE DAMAGE (Anyone fire) I $ 1,000,000
<br /> r-l MED EX? (Anyone person) 1$ 10,000
<br /> AUTOMOBIL.E LIABILITY 105/01/05 COMBINED SINGLE LIMIT $ 1,000,000
<br />A ~ ANY AUTO 74978992 (AOS) 05/01/06
<br />A ' ALL OWNED AUTOS \74978994 (VA) 105/01/05 05/01/06 BODlLY INJURY 1$
<br /> ~ SCHEDULED AUTOS (Per person)
<br /> HIRED AUTOS I BODILY INJURY 11$
<br /> R NON-OWNED AUTOS I I (Per accident)
<br /> -I PROPERTY DAMAGE 1$
<br /> pAGE LIABILITY I I \ AUTO ONLY - EAACCIDENT $
<br /> ANY AUTO II I OTHER THAN AUTO ONL. Y:
<br /> 11 EACH ACCIDENT $
<br /> AGGREGATE $
<br /> - ~CESS LIABILITY I 105/01/05 ! EACH OCCURRENCE $ 1,000,000
<br />A X UMBRELLA FORM 17977-05-65 05/01/06 AGGREGATE $ 1,000,000
<br /> OTHER THAN UMBREL.LA FORM I $
<br /> WORKERS COMPENSATION ANa. I 1105/01/05 X I T"6~ySl~MT);!S I I OJ~
<br /> I EMPLOYERS' LIABILITY
<br />B 10WBRMF5811 (WI) 105/01/06 EACH ACCIDENT " $ 1,000,000
<br /> THE PROPRIETOR! ,~ 105/01/06 1$ 1,000,000
<br />D Pl'NC~ 110WNMF5810 (AOS) 05/01/05 DISEASE - POLICY LIMIT
<br /> PARTNERSIEXECUllVE 'I DISEASE - EACH EMPLOYEE I $ 1,000,000
<br /> , OFFICERS ARE: EXCL
<br /> THER 114914809 105/01/05 1105/01/06 I
<br />C PROFESS IONAL LIAS 1,000,000
<br /> 1 I I
<br />DESCRIPTION OF OPERATIONSIL.OCATIONSIVEHICL.ESISPECIAL.LTEMS
<br />THE CITY OF SANTA ANA, ITS OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSUREDS UNDER THE GENERAL
<br />LIABILITY COVERAGE AS REQUIRED BY CONTRACT W ITH THE NAMED INSURED,
<br />CERTIFICATE HOLDER CLE-001436866-02 CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POL.ICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, THE INSURANCE COMPANY WILL ENDEAVOR TO MAIL
<br /> CITY OF SANTA ANA 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br /> 20 CIVIC CENTER PLA~i\"I!,\-R'! )\ 'e]) !- '; TO FOl\.N -------
<br /> SANTA ANA, CA 92701 -' .,;,;,,/ " BUT FAIL.URE TO MAIL SUCH NOTICE SHAL.L.IMPOSE NO OBLIGATION OR L.IABILlTY OF
<br /> //L ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
<br /> ,/:,_Af^ d " A, AUTHORIZED REPRESENTATIVE -7" -~.--7. -A
<br /> Timothy M. Sasser V-e~... - .$"irt /
<br />ACORD 25 (11/05) - / - L~~r; sui! S~~.:.cJy El ACORD CORPORATION 1988
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