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<br />From: Milissa Gonzalez Pt Pacific Unified Insurance FaxID: 31Q-.37D-S454 To: Lynda Kelly <br /> <br />Date: 7112/2007 02'00 PM F';lge: 4 of 5 <br /> <br />IMPORTANT <br /> <br />If the certificate holder Is an ADDITIONAL INSURED, the policy(ies} must be endorsed, A statement <br />on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may <br />require an endorsement A statement on this certificate does not confer rights to the certificate <br />holder in lieu of such endorsement(s), <br /> <br />DISCLAIMER <br /> <br />The Certificate of Insurance on the reverse side of this form does not constitute a contract between <br />the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it <br />affirmatively or negatively amend, extend or aller tile coverage affofded by the policies listed thereon. <br /> <br />.-1......-..."...... <br />..t" "..or,. <br />""\""" V <br />~'1J <br /><1.S 1'. <br />~~ Of,b <br />I " '1? <br />A, ../t;ri/ ~ ~1\f <br />,":o,JS{ Sf:{..........J. <br />q~']t,: t s/ ' <br />Llty . .....Ct.!. <br /><1110 <br />rl]e <br />:Y <br /> <br />ACORD 25 t2001108) <br />