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ACORDTM CER.TUFICATE OF WORKERS' COMPENSATION COVERAGE DATE CMnvoD/YYI <br /> 8/22/2006 <br /> THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> EXTEND OR ALTER THE <br />THIS CERTIFICATE DOES NOT AMEND <br />Driver Allian[ Insurance Services, Inc. , <br />" COVERAGE AFFORDED BY THE POLICIES BELOW. <br />fransamerica Pyramid <br />The <br />600 Montgomery Street, 9`h Floor INSURERS AFFORDING COVERAGE <br />San Francisco, CA 941 I 1 <br />Phone: (415)403-1400 Fax (415)402-0773 <br />R <br />D <br />INSURER A, Nonprofits' United Workers' Com ensation Grou <br />INSU <br />E INSURER D- In$Drancf CO ra[IOn OP HanDOVCr <br />Orange County Conservation Corps <br /> INSURERC <br />1853 N. Ra}'TDOl1d AVf <br /> INSURER D_ <br />ADaheim, CA 92801-I I I7 <br /> INSURER E <br />COVERAGES This Cedificale is na imentlee Ip speuty all eneorsements, coverages terms. conditions and excursions of the polities shown. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSURANCE AFFORDED BV 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 />INSR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS <br />LTR EFFECTIVE E%PIRATION <br /> DATE MMIODIYY DATE MMIODIYV <br /> GE NERAL LIABILITY EACH OCCURRENCE $ <br /> COMMF.RCIAI GENERAL LIABILITY FIRE DAMAGE (Any one Orel $ <br /> CLAIMS MADE OCCUR MED E%PENSE IMY Ore persm $ <br /> PERSONALBADV INJURY $ <br /> <br /> GENERAL AGGREGATE $ <br /> GE NL AGGREGATE LIMIT APPLIES PER: PRODUCTS~COMP/OP AGG $ <br /> PRO- <br /> POLICY JECT LOC <br /> AU TOAfOBILE LIABILITY ~ COMBINED SINGLE LIMIT $ <br /> c (Ea accitlent( <br /> ANV AUTO gyJ <br />v $ <br /> AIL OWNED AUTOS !'O _ BODILY INJURY $ <br /> '~ ~ (Per <br />erson) <br /> UTOS ^ ~~ ~ p <br /> H RED AUTOS ~~CjR ~ GA ~~~ (PerD cden ARV $ <br /> NON-OWNED AUTOS Q1 \ $ <br /> `a <br />Y <br />\J ` <br />/ <br /> G ~ <br />" <br />' / PROPERTY DAMAGE $ <br /> - _ __ ~ (Per acaeenU <br /> $ <br /> / <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: <br /> AGG $ <br /> EXCESS LIABILITY EACH OCCURRENC $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBI F $ <br /> RETENTION <br /> WORKERS' COMPENSATION ANO WC STATU- X OTH- <br /> EMPLOYERS LIABILITY TORY LIMITS ER <br /> <br />A NPU-WCGOO-?006 I/I /2006 1/1/2007 EL-EACH ACCIDENT s50Q000 <br /> E L DISEASE - EA EMPLOYEE g $OO,000 <br /> E L DISEASE -POLICY LIMIT g $OO,000 <br /> OTHER <br />R Pxcess Workers Compensation H35-0402601 1/1/2006 1/1/2007 $25, 000,OOOx $500,000 <br />DESCRIPTION OF OPERATIONS/LODATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS <br />Evidence of Covfrage of Workers' Compensation <br />CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOULD ANY OF THE PROVE DESCRIBED POLICIES OE CANCELLED BEFORE THE EXPIRATION <br />NPU-OC CC-OSY DATE iHEREOE THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE <br />C ily OL San[e AOa TO mE CERTIFICATE HOLDER NAMED TO THE LEFT, BUl FAILURE TO DO SO SHALL IMPOSE NO <br />~~/OrklOrce In VCStment Hoard OBLIGATION OR LIPBILITV OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br />P. n. HO% 1988 M-73, REPRESENTgiNES. <br />Santa Ana <br />CA 92702 AUTHORIZED REPRES ATIVE <br />, ao1. <br />ACORD 255 (7/97) .~ ©ACORD CORPORATION 1988 <br />TOi CSGDOCAMASTERSCmIfi<a~e of I,labliry Inswence ACOWYtS-$-I <br />