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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D <br />HENNE-J <br />oATE(MNUDD/YYYY► <br />09/07/07 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Crosby Insurance, Inc. <br />P. 0. Box 31150 <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />Anaheim CA 92809 <br />Phone : 714-221-5200 Fax :714-221-5210 <br />INSURERS AFFORDING COVERAGE <br />--- --. __ ------ <br />INSURER A: Golden Cagle Inauranco Corp_ <br />NAIC III <br />----- <br />INSURED------- <br />INSURER B: <br />John Sheffield <br />Hennesse & Henness@ <br />17300 17 h Street Jy251 <br />Tustin CA 92780 r <br />INSURER C. <br />INSURER 0: <br />X1 COMMERCIAL GENERAL LIABILITY <br />INSURER E: <br />06/06/07 <br />06/06/08 <br />COVERAGES - ©L4& <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 />POLICY EFFECTME <br />DATE MMI) <br />POLICY EXPIRATION <br />DATE MMlDD/YY <br />_ LIMITS <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATI E <br />GENERAL LIABIUTY <br />John Sheffield <br />EACH OCCURRENCE $ 1,000,000. <br />A <br />X1 COMMERCIAL GENERAL LIABILITY <br />CBP9595827 <br />06/06/07 <br />06/06/08 <br />PREMISES Eaocc_ure_nce) $ 100,000• <br />CLAIMS MADE D OCCUR <br />MED EXP (Any, one person) s5,000. <br />PERSONAL & ADV INJURY S1,000,000. <br />GENERAL AGGREGATE $ 2 , 000 , 000. _ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG E 2 , O O O , OO 0 . <br />POLICY PRO- <br />JECT LOC <br />--- - ------ -- <br />A � <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT $1,000,000. <br />(Ea accident) <br />BODILY INJURY <br />(Per person) E <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />X <br />X <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />CBP9595827 <br />06/06/07 <br />06/06/08 <br />BODILY INJURY $ <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE UABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ — <br />ANY AUTO <br />AUTO ONLY: AGG E <br />EXCESS/UMBRELLA LUUBLITY <br />EACH OCCURRENCE E <br />OCCUR n CLAIMS MADE <br />AGGREGATE S <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />S <br />WORKERS COMPENSATION AND <br />TORY LIMBS ER <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />— <br />E L. EACH ACCIDENT $ <br />E L. DISEASE - EA EMPLOYEE S <br />OFFICER/MEMBER EXCLUDED? <br />If yes. describe under <br />SPECIAL PROVISIONS below <br />-------------..._... ...._......—_-. .... _...... <br />E.L. DISEASE - POLICY LIMIT $ <br />OTHER <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*If cancelled for non-payment of premium, 10 days notice of cancellation <br />will be given. <br />CERTIFICATE HOLDER CANCELLATION <br />CITYSAN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Santa Ana <br />DATE THEREOF, THE ISSUING INSURER WILL EMAIL *30 DAYS WRITTEN <br />Public Works Agency <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT O�BmOSHALL <br />Michele Walker <br />P.O. Sox 1988 <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TME INSURER, ITS AGENTS OR <br />Santa Ana CA 92702 <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATI E <br />John Sheffield <br />ACORD 25 (2001108) 0 ACORD CORPORATION 1988 <br />\Y f v <br />