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ACORD CERTIFICATE OF LIABILITY INSURANCE VIOP ID(MMIDD <br />ETNTN-2 0 4 03 DATE4/03IYY 7 <br />07 <br />PRODUCER <br />Chapman s Associates <br />License #0522024 <br />P. O. Box 5455 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <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 POLICIES BELOW <br />TYPE OF INSURANCE <br />Pasadena CA 91117-0455 <br />Phone: 626-405-8031 Fax -.626-405-0585 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />INSURER A: Everest National <br />INSURER B: <br />GENERAL LIABILITY <br />Vietnamese Community of Orange <br />Countyy <br />1618 F. First Street <br />Santa Ana CA 92703 <br />INSURER C: <br />INSURER U. <br />INSURER E: <br />rn%jr_c A rrc c <br />THE POLICIES OF INSURANCE LISTED BELOW 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 />LTR IKSRC <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MMIDD/YY <br />DATE MWDDD//YTl N <br />LIMITS <br />P.O. Box 1988 M-25 <br />REPRESENTATIVES. <br />GENERAL LIABILITY <br />Santa Aria CA 92702 <br />EACH OCCURRENCE $ <br />PREMISESEEaa occcureennce) $ <br />COMMERCIAL GENERAL LIABILITY <br />MED EXP (Any one person) $ <br />CLAIMS MADE 1:1 OCCUR <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG $ <br />POLICY 7 ECT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ <br />BODILY INJURY <br />(Per parson) $ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per accident) $ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />_ <br />a" <br />PROPERTY DAMAGE $ <br />(Per accident) <br />r ' <br />GARAGE LIABILITY <br />y :: <br />/ <br />AUTO ONLY - EA ACCIDENT. $ <br />OTHER THAN EA ACC $ <br />ANY AUTO <br />- <br />AUTO ONLY: qGG $ <br />EXCESSIUMBRELLA LIABILITY <br />,. <br />” '1,r <br />EACH OCCURRENCE $ <br />OCCUR CLAIMS MADE <br />p„�"' <br />AGGREGATE $ <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />TORY LIMITS I ER <br />A <br />EMPLOYERS'LIABILITY6600000372071 <br />ANY PROPRIETORIPARTNER/E)CECUTIVE <br />OFFICER/MEMBEREXCLUDED? <br />04/01/07 <br />04/01/08 <br />E.L. EACH ACCIDENT $1000000 <br />E.L. DISEASE -EA EMPLOYE $ 1000000 <br />If yes describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT $ 1000000 <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />The City of Santa Ana, its Officers, Agents, Officials, Volunteers & <br />Employees are included as additional insured with respect to the operations <br />of the named insured. "Ten day notice of cancellation applies for <br />non-payment of premium." <br />CERTIFICATE HOLDER CANCELLATION <br />ciTYOFS <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE 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 />City of Santa Ana/CDBG <br />Comm. Dev. Agy <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />P.O. Box 1988 M-25 <br />REPRESENTATIVES. <br />AUTdORWEDREPR <br />Santa Aria CA 92702 <br />AGO RD 25 (2001/05) <br />0 ACORD CORPORATION 1988 <br />