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ACORD� CERTIFICATE OF LIABILITY INSURANCE <br />12i9i2o <br />PRODU'.,ER (714) 836 -9945 FAX: (714) 836 -9946 <br />'2he Empire Company <br />550 Parkcenter Drive <br />Suite 205 <br />Santa Ana CA 92705 -3521 <br />8 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />Peranich Reporting, Inc. <br />5241 E Santa Ana Canyon #100 <br />Anaheim Hills CA 92807 <br />INSURER A: Preferred Employers Ins. <br />10900 <br />INSURERB: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />OVERAGFS <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE IMIT HOWN MAY HAVE BE N REDUCED BY PAID CLAIMS. <br />INSR <br />ADD'L <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MM /DD/YY <br />POLICY EXPIRATION <br />DATE fMMIDD/YYI <br />LIMITS <br />GENERAL <br />LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR <br />A R ENC <br />$ <br />DAMAGE TO RENTED <br />PR MI ES LE, oc urr nce <br />$ <br />MED EXP An one erson <br />$ <br />PER NA D INJURY <br />$ <br />GEN. ERALAGGREGATE <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />POLICY T LOC <br />PRODUCTS - COMP/OP A <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />BODILY INJURY <br />(Per person) <br />$ <br />BODILY INJURY <br />(Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />GARAGE LIABILITY <br />ANY AUTO <br />EXCESS /UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />DEDUCTIBLE <br />RETENTION <br />APPO�j�J1 j AS <br />r .RV <br />Laai'ct <br />Assistant City <br />O f,(, <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA AC $ <br />AUTO ONLY: <br />AGG $ <br />$ <br />$ <br />$ <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR /PARTNER/EXECUTIVE <br />OFFICER /MEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />WKN117683 -6 9/1/2008 <br />9/1/2009 <br />WC STATU- OTH- <br />I ER <br />E.L. EACH ACCIDENT $ <br />1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ <br />1,000,000 <br />E.L. DISEASE -POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />*10 day notice of cancellation applies for non - payment of premium. <br />icnTlGl/+ATr 11�• e��r� <br />City Of Santa Ana <br />Attn: Rosa Flores <br />P.0 Box 1988 <br />Santa Ana, CA 92701 <br />ACORD 25 (2001/081 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br />FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />AUTHORIZED REPRESENTATIVE <br />Irica Hornaday /ERICA �%�'iGGGt�'(d- t+•t,�oGZCS- <br />© ACORD CORPORATION 1988 <br />