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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DB rDATE(MWDDNYYY) <br />LTR <br />HENNE-J <br />06/11/08PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <br />TYPE OF INSURANCE <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Crosby Insurance, Inc. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. O. Box 31150 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />Anaheim CA 92809 <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE rX ] OCCUR <br />Phone: 714-221-5200 Fax: 714-221-5210 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />�� / <br />I ,W■`�// <br />INSURER A: Golden Eagle Ins Corporation <br />INSURER B: <br />1!!A <br />Hennesse Sr HeIlnesse LLC <br />17300 17 h Street, Jy251 <br />INSURER C: <br />INSURER D: <br />Tustin CA 92780 <br />INSURER E: <br />CAVFRA.fIFC <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 />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MM/DD/YY <br />DATE DD <br />MMI/YY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE rX ] OCCUR <br />CBP9595827 <br />06/06/08 <br />06/06/09 <br />EACH OCCURRENCE $1,000,000 <br />PREMISES(Eaoccurence) $ 100,000 <br />MED EXP (Any one person) $5,000 <br />PERSONAL & ADV INJURY $ Excluded <br />GENERAL AGGREGATE $2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY JECT LOC <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) $1,000,000 <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />A <br />X <br />X <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />CBP9595827 <br />06/06/08 <br />06/06/09 <br />BODILY INJURY $ <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />ANY AUTO <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />A <br />EXCESSIUMBRELLA LIABILITY <br />X OCCUR El MADE <br />CU 8374163 <br />06/06/08 <br />06/06/09 <br />EACH OCCURRENCE $1,000,000 <br />AGGREGATE $1,000,000 <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />STA_ <br />EMPLOYERS' LIABILITY <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYE $ <br />It yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />E.L. DISEASE -POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS 1 <br />*If cancelled for non-payment of premium, <br />will be given. 10 days notice of cancellation <br />/ <br />?; h.._ <br />CERTIFICATE HOLDER ,.,,..,.�..._..... <br />City of Santa Ana <br />Public Works Agency <br />P.O. Box 1988 <br />Santa Ana CA 92702 <br />CITYSAN ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />DATE THEREOF, THE ISSUING INSURER WILL 12WAZINNIOWUL *30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />