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25S - GOV LIAISON SVC
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Last modified
1/3/2012 4:29:58 PM
Creation date
7/1/2008 5:53:08 PM
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City Clerk
Doc Type
Agenda Packet
Item #
25S
Date
7/7/2008
Destruction Year
2013
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~~ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 4/08/2008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION <br />State Farm Insurance, Pat Dady -Agent ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />15215 Shady Grove Road, Suite 102 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Rockville, MD 20850-3235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />t INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br /> <br />THE FERGUSON <br />INSURER A: State Farm Fire and Casualty Company 25143 <br />GROUP LLC <br /> <br />SUITE 300 INSURER B: <br /> <br />1130 CONNECTICUT AVE NW INSURER C: <br />WASHINGTON DC 20036-3981 INSURER D: <br /> <br /> <br />A /'~c~ INSURER E: <br />OOVEP <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 CIAIMS. <br /> INSR <br />LTR ADD'L <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER POLICY EFFECTIVE <br />DATE (MM/DD POLICY EXPIRATION <br />DATE (MMfDD/Yl') <br />LIMITS <br />X X GENERAL LIABILITY 99-BU-8962-7 4/8/08 4/8/09 EACH OCCURRENCE $ 1, 000, 000 <br /> X COMMERCIAL GENERAL LIABILITY PRAEMISES Eaocwrrence $ 100, 000 <br /> CLAIMS MADE OCCUR MEDEXP An one erson $ 5, 000 <br /> X Hired Auto PERSONA O <br /> L&ADVINJURY $ <br /> X Nonowned Auto GENERAL A <br />R <br />' 2 <br />000 <br />000 <br /> ' GG <br />EGATE , <br />, <br />$ <br /> GEN <br />LAGGREGATE LMffAPPUES PER: <br />PRO- PRODUCTS - COMP/OP AGG $ 2 , O O O , O O O <br /> POLICY JECT LOC <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> <br />ANY AUTO <br />(Ea accident) $ <br /> <br /> ALL OWNED AUTOS BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> <br /> PROPERTY DAMAGE <br /> $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: <br /> AGG $ <br />X EXCESS/UMBRELLALIABILITY 99-BU-8978-1 4/8/08 4/8/09 EACH OCCURR 4 <br />000 <br />000 <br /> ENCE , <br />$ <br />, <br /> X OCCUR ~CLAIMSMADE AGGREGATE $ 4, 000, 000 <br /> <br /> DEDUCTIBLE <br /> X RETENTION $ 10000. <br /> <br />X WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY 99-M3-2306-1 4/8/08 4/8/09 WCSTATU- X OTH- <br /> TORY LIMITS ER <br /> ANY PROPRIETORlPARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1, 000, 000 <br /> If yes, describe under EL DISEASE - EA EMPLOYEE $ 1, 0 0 0 , 0 0 0 <br /> SPECIAL PROVISIONS below E.LDISEASE-POLICY LIMIT $ 1,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS f LOCATIONS !VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT !SPECIAL PROVISIONS <br />Legislative Lobbyist <br />CERTIFICATE HOLDER CANCELLATION <br />i.i~y o= Santa tuna Its <br />Employees, Agents, Volunteers <br />& Representatives <br />20 Civic Center Plaza <br />,Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLK:IES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATNE /~ <br />Pat Dady, Agent 301-948-4414 .: _ ~ ~~, ? , J~ r <br />132849 03-13-2007 ~ ~ w _ <br />
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