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<br />ACORDTM CERTIFICATE OF WORKERS' COMPENSATION COVERAGE I DATE (MMlD1lIYY) <br /> 12/28/2006 <br /> THIS CERTlRCA TE IS ISSUED AS MA ITER OF INFORMATION ONLY <br />PRODUCER AND CONFERS NO RIGHTS UPON THE CERTlRCA TE HOLDER. <br />Alliant insurance Services, [nc, THIS CERTlACATE DOES NOT AMEND, EXTEND OR ALTER THE <br /> COVERAGE AFFORDED BY THE POUCIES BELOW. <br />The Transamerica Pyramid <br />600 Montgomery Street, cjh Floor INSURERS AFFORDING COVERAGE <br />San Francisco, CA 941 ] I <br />Phone: (415)403-]400 Fax: (4J5) 402-0773 <br />INSURED INSURER A: NonProfits' United Workers' Compensation Group <br /> INSURER a: Safety National lnsunmce Company <br /> Orange County Conservation Corps INSURER c' <br /> 1853 N, Raymond Ave <br /> Anaheim, CA 9280]-1117 INSURER 0 <br /> IN.~URER E <br />COVERAGES thiS C6rtif1c.ate IS not intended to ~ity an endo~.m8nU:t =wrage.., terms, condtfionaand eXClusiOns of the policie'i shOwn <br />THF- pmlES Ue- N<iURAN(,;!: LISTED BELOW HAVE B!:!:N 1<i<iU!:LJ I U I H!: IN:iURED NAMI:D ABOVE FOR THE pOLle v PERIOD INDICA 11:1), NU I VYl H I <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC 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. AGGREGATE LIMITS SHOWN MAY HAVE I3IOEN RE;DUCED BY PAID CLAIMS, <br />INSR TYPE OF INSURANCE POUCY NUMBER POUCY POUCY UNITS <br />LlR EFFECTIVE EXPIRATION <br /> DAn; IMMlDDIYYl DAn; 'MMIDDIYY) <br /> GENERAL UABllJ'lY i EACH OCCURRENCE S <br /> COMMERCI-'l GENERAL LIABIlITY i FIRE DAMAGE (Anyoneti"'l S <br /> : CLAIMS MADE I I OCCUR ! MED EXPENSE (Ityae~ S <br /> I PERSONAL &. ADV INJURY $ <br /> I GENERAL AGGREG/\ TE $ <br /> GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMPIOP AGG S <br /> POliCY I l.i~ I I LOG <br /> AUTOMOBILE LlABn.rrr COMBINED SINGLE LIMIT S <br /> ANY AUTO (Es acciden1} <br /> S <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS {Per ptDOn) <br /> i $ <br /> HIRED AUTOS ! SODIL Y INJURY $ <br /> NOI\I.OWNED AUTOS I (Per acridenl) l <br /> ! ! PROPERTY .DAMAGE S <br /> I I (PerllCCldenl) S <br /> GARAGE UASIUTY AUTO ONL\' -EA ACCIDEi'lT $ <br /> ANY AUTC I OTHER THAN I EAACC S <br /> J AUTO ONLY: I N;l3 S <br /> EXCESS L1A8ILITY EACH OCCURRENC $ <br /> OCCUR I I CLAIMS MADE AGGI<rGA TE S <br /> I S <br /> DEDUCTIBUO S <br /> RETENTION <br /> i WORKERS' COMPENSATION AND I WCSTATU. I X I OTt-f. <br /> EMPLOYERS UABtUTY TORY L1MI]1; ER <br />A NPU-WCGOO-2007 I/lI07 l! 1.08 E,L EACH ACCIDENT s 500.000 <br /> E,L DISEASE -EA EMPLOYEE $ 500.000 <br /> E.L DISEASE -POLl,-')' LIMIT S 500.000 <br /> OlllER <br />B Excess Worker's Compensation SF-IF8J-CA 1I1107 J II .oS $25. 000,000 x $500,000 W C <br />DESCRIPTION OF OPERA TION5Il.OCATlON5NElflCl.ES/EXCWSIONS ADDED IN ENDORSEMENTlSPECIALIPROVISIOHS $500,000 xs $500,000 EL <br />Evidence of Workers' Compensation Coverage , <br /> I <br />CERTlFICA TE HOLDER I I ADDITIONAL IHSURED; INSURER LETTER; CANCEUA TlON <br /> liHUULU Am OF ,nt MUV~ UO."~IOl:.V C """"l;LL!:IJ BEFORE lHE~~I<AIIUN <br /> NPU-OCCC~27 DATE THEIlEOF, THE ISSUING INSUIlEIl WILL ENOEAVOR TO MAlL ~ DAYS WRIITEN NOTICE <br />Santa Ana WlA Administration Office TO THE CERnFICATE HOLDER NAMED TO THE LEFT, BUT FAilURE TO DO SO SHA1..LIMPOSE NO <br />J 000 East Sanlll Ana Boulevard, #200 OaUGATION OR UABIUn- Of ANY KlNO UPON THE INSURER, ITS "-GENTS OR <br />Santll Ana, CA 9270] IlEPIlESENTATlVES, .J-., I ~ <br />ATTN: Lydia Morgan AUTHORIZEDREPRES'Ii""TIVE . ~ l.t.Y+- <br />ACORD 25-S (7197) \.fl~ ,~ <br />TO:\CSG\DOOM TE - @ACUKU l;URPORATlON 1988 <br /> <br />AS RS>.Cel't1fj~,-, orLiabihty lnsW'MCe AC01lD2>-.8.1 <br /> <br />APPROVED AS TO FORM <br />.----' <br />p~ <br />i Lorena aloza <br />Assistant City Attorney <br /> <br />