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<br />ACORD <br />'" <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />PRODUCER <br /> <br />Tasman Insurance Services, LLC <br />3 Sablewood Circle <br />Ladera Ranch, CA 92694 <br />(949)276-5515 <br /> <br />DATE (MM/DDIYY) <br />10/04/06 <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 />I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC # <br />CNA Insurance <br /> <br />I INSURER A: <br />INSURER B <br />i INSURER C, <br />INSURER 0: <br />INSURER E: <br />COVERAGES I INSURER F <br />THE POLICIES OF INSURANCE LISTED 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 />iINSR' ADO'L I .. - POLICY NUMBER I POLICY EFFECTIVE I POLICY EXPIRATION I <br />: LTR IINSRD: TYPE OF INSURANCE DATE (MM/DDIYY) DATE (MMIDDIYY) <br />! GENERAL LIABILITY <br />I' COMMERCIAL GENERAL LIABILITY <br /> <br />.1 I <br />I <br />I EXCESS LIABILITY <br />. I I OCCUR <br />I <br /> <br />II OEOUCTIBLE <br />I RETENTION <br />I' WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />I E I ANY PROPRIETOR I PARTNER I EXECUTIVE <br />I OFFICER I MEMBER EXCLUDED? <br />I If yes, describe under <br />I SPECIAL PROVISIONS below <br />! OTHER <br />I A I Professional Liability I MCA 27 619 57 73 09/29/06 09/29/07 Each Occ 1.000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />I <br /> <br />INSURED <br /> <br />,)Oct <br />A- / :tD') lc> <br /> <br />Robert Tyler Code Consultant <br />2008 Centella PI <br />Newport Beach, CA 92660-3614 <br /> <br />, <br />I <br /> <br />! CLAIMS MAOE I I OCCUR <br /> <br />B <br /> <br />I <br /> <br />I <br />I . <br />I <br />j' ;'''pC"" '" <br />..',) .' <br />.' . ~ c; 'I ( - ;~/. <br />~. ....-'.c, I <br />__-' ~ -j ,I " <br />!-/:::::'r \. '. ,,,Ii ;<.,~. <br /> <br /> <br />RECEIV:ErJljLjOi <br />NOV 0 8 20106 <br /> <br />I! <br /> <br />., <br />I <br /> <br />, <br />'C <br />I <br /> <br />i GARAGE LIABILITY <br />Ii' ANY AUTO <br /> <br />ID <br /> <br />CLAIMS MADE <br /> <br />SANTA ANA PLANNING DEPT <br /> <br />CERTIFICATE HOLDER <br /> <br />LIMITS <br />I EACH OCCURRENCE <br />DAMAGE TO RENTED <br />. PREMISES (Ea occurence) <br />I MED EXP (Anyone person) <br />PERSONAL & ADV INJU RY <br />I GENERAL AGGREGATE <br />, PRODUCTS - COM PlOP AGG <br /> <br />I <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br /> <br />I BODILY INJURY <br />(Per person) <br />I BODILY INJURY <br />(Per accident) <br /> <br />I PROPERTY DAMAGE <br />(Per accident) <br />AUTO ONLY - EA ACCIDENT <br />I <br />, OTHER THAN EA ACC <br />, AUTO ONLY' AGG <br />I EACH OCCURRENCE <br />AGGREGATE <br />I <br /> <br />! i OTH-, <br />ER i <br /> <br />WC STATU- <br />I TORY LIMITS <br />, E.L. EACH ACCIDENT <br />I E L OISEASE - EA EMPLOYEE I <br />E.L. DISEASE - POLICY LIMIT <br /> <br />1,000,0001 <br /> <br />CANCELLATION <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />I EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil <br />15 DAYS WRlnEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO <br />I THE LEFT, B T FAILUR TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KI N INSURER, ITS AGENTS OR REPRESENTATIVES. <br />I AUT RI 0 R ENTATIVE <br /> <br />City Of Santa Ana <br />20 Civic Center Place M-20 P.O. Box 1988 <br />Santa Ana, CA 92702 <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br /> <br />ORATION 1988 <br />