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<br />'11 CORD,'� CERTIFICATE OF LIABILITY ------
<br />LITY INSURANCE =D1.,TE)
<br />- \ lnsttrance T,ic: 00O3S50 ON LYCAND FCONFERSSNOERIGHTSUPONRTHE ICEki'IF rp' ..
<br />`? %I I'Otxne Centre Diive, Suite 500 HOLDER. THlS CERTIFICATE DOES NOT AMEND, Ea. "i'EN�
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<br />S „t Uie�c, C.� U2122 ALTER THE COVERAGE AFFORDED BY THE POLICIES 8ELOt1`.
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<br />- -- INSiJRERS AFFORDING COVERAGE ,�
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<br />;Nz JREP A Federal Insurance
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<br />Tt!1es13 Ct. Ste 1 f )0 �y!�/"t� _b td =.!REP r Lloyd's of London - -- - -- 3. 1
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<br />'-E PC!L!CiES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTtVi'rH5TAN_ Oit
<br />PER I \14, HE I S R A C CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Jr_
<br />i.t PER I AIW THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONC OF SUC.
<br />rU<' ES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. IO < F s
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<br />TYPE OF !NSl lae
<br />fiF1eFRAL LIABILITY
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<br />GA fZAGE L r Mini:. iTY
<br />M EXCFSSlUriBRELLA LIABILITY
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<br />'"+FIIcRS COMPENSA 7101`4 AND
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<br />ocrt I lcz= 'ULIUY EXPIRATION
<br />35$77916 LIMITS
<br />4.1612009 E`
<br />4116i2010 CH 0C ",- RPF0CF
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<br />73546685 I 4/16/2009 4!16/2010 I
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<br />4/16/2009
<br />APPROVED
<br />7986.5288
<br />HTL. B3881 N74609
<br />W15L1009PNPT
<br />TO FORM
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<br />4/16/2009
<br />4/16/2010
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<br />Professional Liability]
<br />4116•'2009
<br />4116;2009
<br />-' ,: r 0"ki:A -101,19 I LOCATIONS/ VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVI
<br />4/16/2010 IS
<br />EL EACH A, ^!CENT S 1 "(1f 11, f ii ll l
<br />IEL. &-,EASE -=A E'IaLOi EEi i• i.000':I') i
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<br />4/16/2010 LI"'II I's 10,000,000 ` °- - ""'
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<br />SELF NSURED P,li'C£ \'TIOT^ ,,.,i
<br />c:xiel•ii the i it} of Santa Ana, their respective officers, employees, agents, volunteers and representatives are Additional Insureds, as respect„
<br />rcgLlircd be conhact, the insurance is primary and nen- contributory, per company specific form,
<br />�'ZLFVI k E HOLDER
<br />CANCELLATION --- °-
<br />SHOULD AWOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THI EE:(, ^ir;:a`;
<br />I it•r DATE THE
<br />Alm Rohe-r t-arroll
<br /><< .ant., - •t,17,9 gird_ and Floor
<br />`f)i2[; Mj 12001
<br />ient # 48624 Mst # 10427
<br />REOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL JU__ _ L•;• yg yylzj r:• _.
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT 1
<br />BUT FAILURE in nc
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<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER 1 - ,r ocuocc1—__ '
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<br />AUTHORIZED REPRESENTATIVE
<br />Michelle Chl'istovhei-son
<br />Cert # 1
<br />Subject:
<br />D CORPORATTF .,-, : -1
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