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<br />ACORD",. CERTIFICATE OF WORKERS' COMPENSATION COVERAGE I DATE (MMlDDIYY) <br /> J 2/2812006 <br />PRO[}l)CER 11itS CERTlRCATE IS ISSUED AS MATTER OF INFORMATION ONLY <br /> AND CONFERS NO RIGHTS UPON THE CERTlACA TE HOLDER. <br />Alliam Insurance Services, Inc. THIS CERTtACATE DOES NOT AMEND, EXTEND OR ALTER 11iE <br /> COVERAGE AFFORDED BY 11iE POUCIE5 BELOW. <br />The Transamerica Pyramid <br />600 Montgomery Street, rjh Floor INSURERS AFFORDING COVERAGE <br />San Francisco, CA 94111 <br />Phone: (415)403-J4oo Fax: (415) 402-0773 <br />lNSt1Rell INSURER A: NonProfits' United Workers' Compensation Group <br /> INSURER B; Safety National Insurance Company <br /> Orange COlIDt)' Conservation Corps INSURER c: <br /> 1 &53 N. Raymond Ave <br /> Anaheim, CA 92801 - JJ Ii INSURER D <br /> INSURER E <br />COVERAGES This Certificate IS not tnlendad \0 tptdfy.n endorlamenu, CO\Ie!1lgel, tenns, concUtionlano aliCClul~ of the policies shOWn <br /> 1,=" uF N"UKANLO'= U",,=u ""Luvv t1AV" """N ."",,"'u 'u AMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWlTH I <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGA1E LIMITS SHOWN MAY HAVE BI:EN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE POUCYNUMBeR POLley POUCY UNITS <br />LlR EFFECTlVE EXPIRATION <br /> DA'IE f-..oDJYYl DA1E IMMJDOIY'f) <br /> GENERAL UABlU1Y i EACH OCCURRENCE i <br /> COMMERCIAL GENERAL LlABl1JT"f i RRE DAMAGE {Any one ."', i <br /> I CLAIMS MADE I I OCCUR MEDEXPENSE~~ $ <br /> I PERSONAL />. ADII INJURY $ <br /> GENEAAL AGGREGATE i <br /> GEN'LAGGREGATE UMIT APPLIES PER. J PRODUCTS-COMPIOP AGG s <br /> POLICY I I j:gT I ! LOG <br /> AUTOMOBILE LlABILlTY COMBINED SINGLE LIMIT i <br />I /IJIY AUTO (Ea llCDdenl) <br /> S <br /> ALL OWNED AIJTQS aODlL Y INJURY i <br /> sc;HEouLED AUTOS ' (Per ptnOfl) <br /> i s <br /> HIRED AUTOS I ! SODIL Y INJURY i <br /> NON-OWNED AUTO= I (Per acridenl) l <br /> I I ! PROPERn .DAMAGE i <br /> I I (per scad",,!; <br /> , $ <br /> GARAGE L1ABIUT'l' AUTO ONLY -EA ACCIDENT $ <br /> AN\'AlITC OTHER THAN I EAACC i ! <br /> i AUTO ONLY: <br /> I 1>00 i <br /> EXCESS UA81UTY ; <br /> EACH OCCURRENC i I <br /> OCCUR I I CLAIMS MADE I <br /> AGGREGATE $ i <br /> I s I <br /> DEDUCTIBLE S <br /> RETENTION <br /> WORKERS' COMPENSATION AND I <br /> 1 EMPLOYERS UABIUTY I I WCSTATU. 1 X! OTI>- <br /> NPU-WCGOO-2007 TORY UMITS . ER <br />A 1/1/07 11l,Q8 E.L EACH ACCIDENT S 500,000 <br /> E.L DISEASE -EA EMPLOYEE $ 500,000 <br /> E.L DlSEASE OLlCY LIMIT S 500,000 <br /> ornER <br />B Excess Worker's CompensatJon SF-IF81-CA 1/1/07 I/l.08 $25,000,000" $500,000 we <br />DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCWSIONS ADDED BY ENDORSEMENT/SPEClALIPROVISIONS $500,000 xs $500,000 EL <br />Evidence of Worker.;' Compensation Coverage I <br />C;ERTlFICA TE HOLDER I I ADDITIONAL INSURED; INSURER LETTEft: CANCELLATION <br /> "" MVV" - '"" <br /> NPU-OCCC-G27 DATE THEREOf, TliE ISSUlNG INSURER WILL ENDEAVOR TO MAlL ~ OAYS WRITTEN NOTICE <br />S8I1ta Ana WlA Administration Office TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT fAilURE TO 00 SO SHAlL IMPOSE NO <br />1000 EllSt Santa Ana Boulevard, #200 OBUGATlON OR UABlUn- OF ANY KlND UPON THE INSlJRER, ITS M>EllTS OR <br />SMW AnI!. CA 9270] REPRESENT AT1VES. J.-7 I ....,...., <br />ATrN: Lydia Morgan AUTHORIZED REPRES'V"~ . ~ ( t Y-+_ <br />ACORD 25-5 (711;7) 'fl' --- <br />TO:\CSG\DODMASTERSl..Certifi - @ACutID CORPORATION 19l1S <br /> <br />!:-lIt' of Llabihty lnsutwtee ACOR.D25-S.1 <br /> <br />APPROVED AS TO FORM <br />.---. <br />T<d~~ <br />' Lorena aloza <br />Assistant City Attorney <br />