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<br />ACORlJ,. CERTIFICATE OF LIABILITY INSURANCE OP ID V~ DATE (MMlDOIYY'fY) <br />BRODE-3 10/06/06 <br />PRODUCER N - '2oCI-I- 03'/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hylant Group - Toledo N-2.oc:A-O~?..o I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />811 Madison Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> . <br />Toledo OR 43604 <br />Phone: 419-255-1020 Fax:419-255-7557 INSURERS AFFORDING COVERAGE jNAle"-- - <br />- -- - -- --_.-- -- - --_.--- - ---"- _.,---- - - - --- --. - -- --- -- - <br />INSURED N - z.oo'-l-037 -0 2- ~, INSUR~~ Phib<1.el1'-J:i0nd~itY~SI" c~_ 18058 <br /> -- -- <br /> , INSURERS' --- ---~ <br /> Jay Broderick dba Mad Science ~------ - --,----- <br /> of West Orange count~ INSURER C t------ <br /> -.--,.-.-.'- ------.-'.- --- - <br /> 3501 w. Moore Ave. S e J INSURER D <br /> Santa Ana CA 94702 -"---'- --,-- - -------.-..- <br /> INSURERE <br /> <br />THE POLICIES Uf' INSURANCE LISTED D[LOW HAVl:: ~EEN ISSUFD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIUD INDICATED NOTWITHSTANDING <br />ANY Rl::QUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH lHIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN_ THE INSURANCl:: AFFORDED flY THE POLICIES DESCKIBED HEREIN IS SUBJECT TO ALL lHE TERMS, EXCLUSIONS AND CONDITIUNS OF SUCH <br />POLICIES. ACGREGAIE LIMITS SHOWN MAY I lAVE BEEN KI:DUCED BY PAID CLAIMS <br /> <br />I::i:~~--C- TYPEOFI~SU~~C--;- POUCYNUMBER- <br /> <br />GENERAL LIABILITY <br /> <br />A X x~ COMMERClALGENFRALLIABILlTY I PHPK187988 <br /> <br />I I -I CLAIMS MADE 1,,_~.1 OCCUR <br /> <br />~ ribuse/Mo_~st_ation PHPK~87988 <br /> <br /> <br />~~EN'L AGGREGATE LIMIT APPLIES 1"l::R: <br />;- , I"OUCY r' I m?1 '-1 LOC <br />, AUTOMOBILE LIABILITY <br /> <br />COVERAGES <br /> <br />POLlC'YEFFECTIVE P UCY EXPIRATION <br />DATE MMlDDNY DATE MMlDDNY <br /> <br />10/15/06 <br /> <br />10/15/07 <br /> <br />10/15/06 <br /> <br />10/15/07 <br /> <br />A <br /> <br />ANY AUTO <br />tj' ALL OWNeD AUTOS <br />. SCHFr]ULEDAUTOS <br />r!.' HIRED AUTOS <br />~x~ NON-OWNED AUTOS <br /> <br />PRPK187988 <br /> <br />10/15/06 <br /> <br />10/15/07 <br /> <br />1- <br /> <br /> <br />l_~J DEDUCTIRLE <br />I Rl::Il::NTION r, <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY I"ROPRIETOR/PARTNER/CXECUTIVl:: <br />OFFICl::R.'MEMBER FXCLUDED? <br />1 ,,~CS, descr,be under <br />SPECIAL I"H.OVISIONS hRluw <br />I OTHER <br /> <br />I <br /> <br />-.-.--,-.---- <br /> <br />LIMITS <br /> <br />1 ~~~gR=- _~s 1 ~Oo... O.QO <br />~R.[M\-~ES~O~cUrence) _$19_ ~..!...9 O. 0 _ <br />MEOI:::XP(Anyonep..rson). $ *15,000 <br />~ERSONAL & AOV INJURY $ :L:"o 00-,000. <br />------ --.--------.- <br />GCNERALAGGkEGATE 1$2,000,000 <br />-----.--------1---=-- .--------- <br />~RODUCTS~OMP~OI" AGG ~~ 000,0 Q.Q. <br />A&M 500,000 <br /> <br />I' COMBINED SINGLE LIMIT <br />.(EaaCCldent) <br /> <br />--;~DILYINJURY.- i~-' - --- <br /> <br />I ~~~~e:~I:nJ}UR-; - - ~1.. - <br />(peraccldf'lll) $ <br /> <br />~OPl::RTY DAMA"F - I $ -- --- <br />I rp~raCCldent) <br />I AUTOONL ~A A,CClD,ENT -l-~-- <br />OTHER THAN _Ell. ACC::_..:....$ _ <br />AUTO ONLY: AGG . S <br />~CH OCCURRENCE _ _+: _ __ ____ <br /> <br />rAGGR>"'T' ~~ _ ~ -- - - - <br />-~-- [$ - <br /> <br />$1,000,000 <br /> <br /> <br />LL DISEASlo - POLICY LIMIT <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLESI EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*Medical payments excludes Participants. Certificate Holder is included as <br />an Additional Insured/Landlord ATIMA. <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR L1AIiILlTY OF ANY KINO UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES, <br />AUTHORI D REPRESENTAT~VE <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />City of Santa Ana <br />888 W Santa Ana #200 <br />P.O. Box 1988 M-23 <br />Santa Ana CA 92702 <br /> <br />ACORD 25 (2001108) <br /> <br /> <br />@ACORD ORPORATION 198B <br />