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<br />Portland 'JR 9122]
<br />Phone: 5G3~296-007'1 1"'.
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<br />,; it c, (.,::F<Tlr:U\TE IS ISSUED AS A MA rTEf~ Of
<br />-';'~L'( .'V~D CmJFEHS NO RIGHTS UPON THE Ct:-Tii!:->:,",';
<br />i,(::UkR, THIS CeRTIFICATE DOES NOT A'i'iEND, Ffi::;~iU Ci\
<br />I\LTER Ti1E COVERAGE AFFORDED BY THE POliCIES ElELOW. ,
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<br />i I;;SURERS AFFORDING CuVERAGE ~AIC # I
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<br />19l~4 A Molalla Ave
<br />Oregon City OR 97045
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<br />COVERAGES
<br />
<br />THE POLICIES Of' INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
<br /> f,NY REOUlfIEMENT, TERf.l 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 I\LL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
<br /> POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />~~~:;)'g~ POLICY NUMBER 3.Lf~fJFFtClW'~5)(f'IRATWN LIMITS
<br />TYPE OF INSURANCE -- DATE MMIODfYY DATE (MMIDDm
<br /> GENERAL LIABILITY EACI-j OCCURRENCE '1,000,000.
<br /> - PPS43008706 02/06/06 02/06/07 tNltU sl,OOD,OOO.
<br />A X ~ COMMERCIAL GENERAL LIABILITY PREMISES (Ea Dccurence)
<br /> -J CLAIMS MADE 0 OCCUR MED EXP (Any ~n~ per-sOl1) SID,OOO.
<br /> -+-,
<br /> PERSONAL & ADV INJURY S 1, ODD, 000.
<br /> ~ ----~._-------
<br /> - GENERAL AGGREGATE S2.000.000.
<br /> ---
<br /> ~<?EN'L AGGREGA:!,E LIMIT AP~,l!Y PER PRODUCTS - COMP/OP AGG '2,000,000.
<br />-- 1---. X l POLICY f--l j~T r lOC
<br /> AUTOMOBilE LIABILITY COMBINED SINGLE LIMIT
<br /> c- (Eaaccldenl) SI,OOO,OOO
<br /> ANY AUTO
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<br /> r~ ALL OWNED AUTOS BODilY INJURY
<br /> IPerparson) ,
<br /> SCHEDULED AUTOS
<br /> ~ 02/06/06 02/06/07
<br />A c"- HIRED AUTOS PPS43008706 SOOIL Y INJURY
<br /> (Perilccident) ,
<br />A ~ NON.OWNED AUTOS PPS43008706 02/06/06 02/06/07
<br />A c"- Hired Auto p~~ PPS43008706 02/06/06 02/06/07 PROPERTY DAMAGE
<br /> IPeraccident) ,
<br /> Damage $50,000
<br /> erAGE LIABILITY AUTO ONLY. EA ACCIDENT ,
<br /> ANY AUTO OTHER THAN EA Ace $
<br /> AUTO ONLY: AGG S
<br /> 5ESSIUMBRELLA LIABILITY EACH OCCURRENCE S 1, 000, 000
<br />., X OCCUR 0 CLAIMS MADE PPS43008706 02/06/06 02/06/07 AGGREGATE s 1,000,000
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<br /> R DEDUCT'BLE ,
<br /> RETENTION SO ,
<br /> WORKERS COMPENSATION AND hO'R'/'L'{M1TS I IIJER-
<br /> EMPLOYERS. LIABILITY
<br /> ANY PROPRIETORJPARTNERJEXECUTlVE E.L. EACH ACCIDENT S
<br /> OFFICER/MEMBER EXCLUDED? E_L DISEASE - EA EMPLOYEE ,
<br /> ~~~b~tS~Wov~s16~s below E.L DISEASE - POLICY LIMIT ,
<br /> OTHER
<br />DESCRIPTION OF OPERATIONS {lOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />The City of Santa Ana, its officers, employees. agents, volunteers and
<br />representatives are named as additional insureds per the attached form. The
<br />insurance is primary per the attached policy form no. (S2001) _
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />The City of Santa Ana
<br />20 civic Center Plaza
<br />Santa Ana CA 92701
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE !:XPIRATlO
<br />DATE THEREOF. ntE ISSUING INSURER WILL ENDEAVOR TO MAil 30 DAYS WRITTEN
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
<br />
<br />IMPOSE NO OBLIGATION OR LIABiliTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />REPRESENTATIVes.
<br />AUTHORlZEO REPRESENTATIVE
<br />. Z2-' "--
<br />
<br />J. Darrin Gross
<br />
<br />ACORD 25 (2001108)
<br />
<br />@ACORD CORPORATION 1988
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