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<br />ACORD <br />'" <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />DATE (NlMlDOIYYYY) <br /> <br />01/31/2006 <br /> <br />THIS CERTIFICATE SS E A ATTER 0 INFOR A ION <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 POUCIES BELOW_ <br /> <br />PROOUCER (626)599-8830 FA (626)599-8831 <br />Pacific General Insurance Services <br />405 E. Santa Clara Street <br />Suite 100 <br />Arcadia, LA 91006 <br />INSUREO Mexican Amerlcan Opportuni ty Foundation <br />401 N. Garfield Avenue ,t - ?-Qu't-I.) f ;;l or <br />Montebello, CA 90640 <br />/r ~/"\..lit-I;J.r-' A......,).v.::J'1 <br />,1- .? CJ '" ,- - I -..I" 0 <br />COVERAGES <br /> <br />- ..)v'l <br /> <br />o7Y- <br /> <br />v.;; <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />IN'URER'" Philadelphia IndellU1ity <br />INSURER B: <br />INSURE.R c: <br />INSURER D: <br />INSURER E: <br /> <br />NAIC# <br /> <br />Insurance Company <br /> <br /> THE POUCIES OF INSURANCE LISTED BeLOW HAVE aEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N01WITHSTANDING <br /> N<Y REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC\JMENT WfTH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO All lliE TERMS. EXCLUSIONS AND CONomONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />, TYPE OF INSURANCE POLICY NUMBER DAlE"MMlDDNVl' OAT"" M~~ LIMITS <br />LTR NSR <br /> GENERAL LlABll.llY PHPK156499 01/30/2006 01/30/2007 EACH OCCURReNCE s 1 000,000 <br /> ~ <br /> X COMMERCIAL GENERAL LIABILITY PREM~ES Es!Xll: ren '.., $ 100 000 <br /> I CLAIMS MADE m OCCUR MED EXP (Anyone par&Otl) , 5,000 <br />A X PERSONAL & MJV INJURY S 1,000,00 <br />'-- <br /> GENERAL AGGREGATE , 3 000,00 <br /> - <br /> GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OPAGG S 3,000 00 <br /> Xl POLICY n ~ n LOC <br /> ~TOMOBlLE LIABRJTY PHPK156499 01/30/2006 01/30/Z007 COMBINED SINGlE lIMIT $ <br /> X ANY AUTO (Eaacddenl) 1,000 OO~ <br /> ..:.:. <br /> ALL OWNED AUTOS BOQll Y INJURY <br /> - , <br /> SCHEDUlED AUTOS (P6rperaon) <br />A X - <br /> - HIRED AlJTOS BODILY INJURY <br /> NON.OWNED AurOS (Pl!lrsccldenl) S <br /> - <br /> ~ PROPERTY DAMAGE $ <br /> /"" fO":-" (Peraccidenl) <br /> GARAGE UABILlTf i\f"tD ,.~ ~ AUTO ONLY - EA ACCIDENT S <br /> R ANY AUTO t-S~"P.?.,J. D ~ OTHER THAN EAACC S <br /> ~ AUTO ONLY; AGG S <br /> BESS/UMBRELLA LlABIUTY ~ <:5 ,,-'t'tOlne~ EACH OCClJRRENCE S <br /> OCCUR 0 ClA>>.4S MADE . \..\5"- Cit AGGREGATE $ <br /> p.$Sls't3f\'t ([ o.f ,,) , <br /> R DEDUCTIBlE $ <br /> RETENTION S , <br /> WORKERS COMPENSATION AND ITORYLlMIT8IIVER" <br /> EMPLOYERS'LIABIUTY <br /> ANY PROPRIETORlPARTNERlEXECUllVE S.L. EACH ACCIOE'fT , <br /> OFFICERlMEMBER EXCLUDED? e.L. D1SEASEi - EA EMPLOYEE S <br /> g~Et~~V':Sr~~S below e.L. DISEASE - POL-ICY UMIT S <br /> OTHER PHPKlS6499 01/30/2006 01/30/2007 <br /> ~-;'ime Coverage See Below <br />A Professional Liability PHPK156499 01/30/2006 01/30/2007 $1,000,000 acC/$3,000,000 acc <br />~.!ESCRlPTlON OF OPERATIONS I L!>CATJONS I VEHICLES' EXCLUSJONs ADDED BY ENDORSEMeNT I SPECIAL PROlo'lStONS <br />Clty of Santa Ana, lts officers, agents and employees are named as additional insureds with <br />espects to all operations by the named insured for general liability only as a funding SOUrce. <br />ten day notice of cancellation shall be given in the event of non-payment of premium <br /> <br />CERTIFICATE HOLDER <br /> <br />City of Santa Ana/Fez Daisy Wheel Network <br />Santa Ana Work Center <br />Attn: Rea Gonzalez <br />1000 E. Santa Ana. Suite 200 <br />Santa Ana, CA 9Z701 <br /> <br />CANCEllATION <br />SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILt. ~ MAIl. <br />-3..Il.....DAYS WRITTEN NOTlCETO THE CERTIFICATe HOLDER NAMEE> TO ll-lE l.EFT, <br />1lWJOOt)(IIIlOOflll1IOOQ~JOl~ <br />~MII?fIlOOlIW( OOOlJI.1KlIJlX~~XXXXXXXXX <br />AUTH RD. RESENTA Vi! <br /> <br /> <br />ACORD 25 (2001/0B) FAX: (714)565-260Z <br />