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<br />4- O CERTIFICATE OF LIABILITY
<br />��
<br />INSURANCE
<br />DATE 07 /302009 Y)
<br />07/30/2009
<br />PRODUCER 805.493.5401
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />PRIMARY & EXCESS INS SERVICES, INC.
<br />CA LICENSE OD06518
<br />PO BOX 2002
<br />THOUSAND OAKS, CA 91358 -2002
<br />-
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COV G AFFORDED BY THE POLICIES BELOW.
<br />.,_ F .._ ;I 3
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: HARTFO jMSUALTYCOMPANY(
<br />LIMITS
<br />INSURER B:
<br />X
<br />BURKE, WILLIAMS & SORENSEN, LLP
<br />444 S. FLOWER ST., SUITE 2400
<br />INSURERC: UNDERWRITERS AT LLOYDS, LbftON
<br />INSURER D:
<br />EACH OCCURRENCE
<br />LOS ANGELES, CA 90071
<br />INSURER E:
<br />S 300,000
<br />MED EXP(An_y one person)
<br />COVERAGES
<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 />INSR
<br />DD'L
<br />TYPE OF INSURANCE
<br />POLICYNUMBER
<br />POLICYEFFECTIVE
<br />DATE MMIDDNYYYj
<br />P0UCYEXPIRATION
<br />DATE IMMIDDPPYYMI
<br />LIMITS
<br />A
<br />X
<br />GENERA- LIABILITY
<br />X COMMERCIALGENERALLIABILITY
<br />CLAIMS MADE OCCUR
<br />72 UUN UR 4713
<br />FORM HIS 00010605
<br />8/1/2009
<br />8/1/2010
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISESjEaoccurreoce )
<br />S 300,000
<br />MED EXP(An_y one person)
<br />$ 10,000
<br />PERSONAL& ADV INJURY
<br />S 1,000,000
<br />X AUTOMATIC ADD'L
<br />!
<br />SEE REMARKS (1)
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />CX
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />POLICY 11 FIP X LOO
<br />•
<br />AUTOMO
<br />BI LE LIABI LITY
<br />ANY AUTO
<br />72 UUN UR 4713
<br />009
<br />8/1/2010
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY
<br />(Per person)
<br />$�
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />APP 0,14
<br />IVIED T f
<br />,'I�
<br />BODILY INJURY
<br />(Per addid.nn
<br />—__
<br />$
<br />X
<br />HIREDAUTOS
<br />NON -OWNED AUTOS
<br />_.
<br />X
<br />JOSE
<br />W. FLE
<br />TT NE
<br />ER
<br />PROPERTY DAMAGE
<br />(Per addMant)
<br />$
<br />_G_A_RAGELIABILITY
<br />AUTO ONLY - EA ACCIDENT
<br />$
<br />OTHER THAN EAACC
<br />$
<br />ANY AUTO
<br />$
<br />AUTO ONLY qGG
<br />•
<br />EXCESS I UMBRELLA LIABILITY
<br />X OCCUR F CLAIMS MADE
<br />72 XHU UR 1585
<br />6/1/2009
<br />! 8/1/2010
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE I $ 10,000,000
<br />$
<br />DEDUCTIBLE
<br />$
<br />RETENTION S
<br />WORKERS COMPENSATION
<br />�( AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICEMMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, descrilue uner
<br />I SPECIAL PROVISIIONS below
<br />" SPECIFIC EMPLOYERS'
<br />CERTIFICATE IS ISSUED
<br />BY ISU I STANTON INS"
<br />4/1/2009
<br />4/1/2010
<br />i WC STATU- 'OTH-
<br />— X'- jQgYLIMITS
<br />E.L. EACH ACCI DENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE$
<br />1,000,000
<br />E.L. DISEASE POLICY LIMIT $ 1,000,000
<br />OTHER
<br />C LAWYERS PROFESSIONAL
<br />BO 595 EO 065670 2009
<br />111512009
<br />1/15/2010
<br />LIMIT: $10,000,000 PER CLAIM AND
<br />LIABILITY INSURANCE
<br />ANNUAL AGGREGATE; SIR: $250,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
<br />NOTEW GENERAL LIABILITYPOLICYEXCLODES PROFESSIONAL SERVICES- REFER TO LAWYERS PROFESSIONAL LIABILITYPOLICY NOTWITHSTANDING THE EXCLUSION IN NOTE (1), PARTIES WITH
<br />WRITTEN CONTRACTS WITH INSURED ARE AUTOMATICALLY INCLUDED AS ADDITIONAL INSUREDS UNDER HARTFORD'S COMMERCIAL GENERAL LIABILITY POLICY FORM HG 0001 0605 INCLUDING
<br />PROVISIONS FOR PRIMARY /NON - CONTRIBUTORY INSURANCE, SEPARATION OF INTERESTS, AND WAIVER OF SUBROGATION TO THE EXTENT THAT COVERAGE MAYBE PROVIDED UNDER THAT POLICY
<br />POLICIES, ENDORSEMENTS, CLARIFICATIONS AND / OR ADDITIONAL DOCUMENTATION IS AVAILABLE UPON REQUEST
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2009101) ©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and Joao are realstered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION
<br />CITY OF SANTA ANA
<br />DATE THEREOF, THE ISSUING INSURER WILL X9G )W)(XO MAIL 30 DAYS WRITTEN
<br />INDHIRA GAGNON I OFFICE OF THE CITY CLERK
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT )*X*X)(9pQJF}EX)%89XCC
<br />200 CIVIC CENTER PLAZA, 7TH FLORR
<br />afii�2199iD�615ffi➢( dGd6)( k�O��> bCXdD6XAQd4X�klfkLlflYi €KXJIMkPf#i(D.�(
<br />SANTA ANA, CA 92702
<br />Ax*x*xy&yMCxXXXXXXXXXXX
<br />AUTHORIZED REPRESENTATIVE
<br />IS/ John A. Bessey, CPCU
<br />ACORD 25 (2009101) ©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and Joao are realstered marks of ACORD
<br />
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