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CERTIFICATE OF WORKERS' COMPENSATION COVERAGE T <br /> Feb 3 <br />2012 <br />PRODUCER <br />NonPro£ts' United Workers' Compensation Group THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />431 1 Street, Suite 200 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />Sacramento. CA 95814 Phone- (916) 764-005 6 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Fez: (916) 880.5251 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Marsh Risk 8c Insurance Services <br />345 California Street <br />Suite 1300 <br />_ <br />San Francisco, CA 94104 INSURERS AFFORDING COVERAGE <br />INSURED <br /> INSURER A Non Profits' United Workers' Compensation Group <br />Association tDr Retarded Citizens Mitl-Cities INSURER B: ACE American ]nsurance Company [NAIL a 22667) <br />'14208 Towne Ave. <br />Los Angeles, CA 9006'1 <br />N,?OU'7-O?O INSURER C: <br />? / Y / t ? U '? t - INSURER D- <br />- ? Z <br />? U y <br />? <br />? INSURER E <br />COVERAGES This Certificate is not intended to s eci all entlort;emenls, Covera es, terms, contlitions aril exdusions of the olicies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSVED TO THE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REOUIREM ENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GE RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVBJECT TO ALL THE TERMS, E%CL USIO NS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS <br />SHOWN MAY HAVE BEEN REDVGED BY PAID CLAIMS. <br />INSR <br />LTR TYPE OF COVERAGE POLCY NUMBER POLICY <br />EFFECTIVE DATE POLICY <br />E%PIRATON DATE LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY RRE DAMAGE (Any one fire) $ <br /> CLAIMS MADE OCCUR MED EXPENSE (Any one person) $ <br /> GENERAL AGGREGATE LIMIT APPLtE9 PER: PERSONAL 8 ADV IWURY $ <br /> POLICY PROJECT LOC GENERAL AGGREGATE $ <br /> PRODUCTS-GOMPIOP AGG $ <br /> AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br /> ANY AUTO (??.>_?TTTa (? ?? , <br />O <br />1 (Each aori0enl) $ <br /> ALL OWNED AVTOS ? ?? ?"? d (_? AA'' <br />)?D??,?p?tURY <br />$ <br /> SCHEDULED ALROS \- (Per pereo^I $ <br /> HIRED AUTOS -°?rr?. -'__: ? BODILY INJVRY $ <br /> NON-OWNED AUTOS j-[I ( `. _, <br />,? (Per ecotlent) <br />--- $ <br /> <br />?. SSI.tiI R;] -, <br />,I;?r(1y <br />l ?: [ <br />PROPER TY DAMAGE $ <br /> y /f, I f ? ? 1"rl C (Per accoenfJ <br /> $ <br /> WC STAT X OTHER <br /> WORKERS' COMPENSATION LIMITS <br />A AND NPLJ-WCG OOI-2012 1/27/12 I/1/l3 E.L. EACH ACCIDENT $500,000 <br /> EMPLOYERS LIABILITY E.L. DISEASE - EA EMPLOYEE $ $00,000 <br /> E.L. DISEASE -COVERAGE LIMIT $ $00,000 <br /> OTHER <br />B EXCESS Workers' Compensation WCL 046245283 1/27/12 I/1/13 535,000,000 x E500,000 WC <br /> $2,000 000 x $500.000 EL <br />DESCRIPTION OF OPERATIONSA_OCATIONSNENICLES/E%CLUSIONS ADDED BY ENDORSEMENT/SPECIAUPROVISIONS <br />Evidence of Workers' Compensation Coverage: Waiver of Subrogatio n provided by Endorsement No. NPUWCG-ARCMIDC-06 <br />CERTIFICATE HOLDER woDlnoNAL INSURED; INSURER LETTER: CANCELLA"1'1(lN <br />NPUWCG-ARC MIDC-W <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />Cit <br />f S <br />nta Ana BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED <br />y o <br />a IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />Clerk of the City Council <br />20 Civic Center Plaza <br />PO Bor 1988 <br />Santa Ana,CA 92 702-1 988 ? <br />" ? <br />? <br /> ??? <br />? <br />? <br />Based on ACORD 25 (2009/09)