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<br />ACOR0, CERTIFICATE OF LIABILITY INSURANCE DATE OMM;CD YyYy)
<br />01/25/2010
<br />213.553.8400 FAX 213.553,8466 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />_ . . ........... I
<br />Wilshire Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />835 Wilshire Blvd 4th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />Los Angeles, CA 90017-2603 ALTER THE COVERAGE AFFORDED BY THE POLICIES EELOW,
<br />INSURER,%-AFFORPI 11 COQ! NAIC #
<br />nited St
<br />soi� IJ� I Nautilus Ins.Co
<br />14000 East Valley Blvd.
<br />mat City of Industry, CA 91746 -.Cfr At Divide Ins.
<br />. ......... .. ..... ....... . . .............. ..... . ..... .. . .... .. . ....... . ............ . .. . .................
<br />---- ._ ........ . ...... ..... ....... . . ................ ...... . . ......
<br />Ti__ iN, URA AC--_ L!srED p 0-V%,' KA, IE SEE"" TO THE JNSjRzD NANAIEED ABOVE FOR THE POLICY PER Of) INDICATED NQTV,,)THS1,Ar,,r_,!NG_
<br />R T C C ^ 40 I T "", 0 A N A� C T 0 R ' T I - 4 F P icy
<br />kIENT Vii-HqES7,�_CT TOV"HICH TH�S CEr-TIrICATE ,�AY EE!S_�,
<br />P0 n*: -Luz r
<br />S 0 E S --,R I 6;� �'�jN Is SUB'- 3 AND '_13NZ)j7.C,1 r, r
<br />HE _ 1� E C T T 0 A, H E TE R �,! 5, EXr_
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<br />j—, ay PA0
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<br />TY. PE i, i . O F JrISURANCL
<br />O 4�POL'Irl ET'P E TYV, E P66E_, E
<br />XP-,,Aj
<br />I
<br />LIMITS NUMBER
<br />G E PL A I ECPCO20000T311/16i 9 11/16)2010 :
<br />1-1, 000, 00
<br />50,00
<br />A
<br />5 on,
<br />SHOULD AIIYOF THE ABOVE DESCRIBED PO,,cjfiS BE CANCELLED BEFORE. TI-E
<br />"
<br />-.P.RA." DATE THEREOF, THE ISSUING INSURER WILL *UX�16 4AIt
<br />D
<br />CITY OF SANTA ANA DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
<br />20 CIVIC CENTER PLAZA M-93
<br />SANTA ANA, CA 92701 KAXX x x x x X)o
<br />ACORD 25 (2001108)
<br />IDACORD CORPORATION 1988
<br />. ...... . ... .......... . ........
<br />. . ......... . ..........
<br />.......... . .
<br />000 00
<br />11000.00
<br />............
<br />1.000,00
<br />AL ii}l63Ok31.6 Y
<br />BAP0200003131 11/16/2009.....1I/16/2010 11/16/2010 1
<br />1,900,00
<br />APPRON/' 0 A S TO FORM
<br />X
<br />X
<br />X MCS-90
<br />... . ............
<br />X Cd99 8
<br />Laura S Shee
<br />GARAGE MLITY
<br />UA
<br />7 iDI, I y
<br />EXCESSUMBRELLA LIABILITY
<br />-7,
<br />FFX0200005131 11/16/2009 11/16/2010
<br />X �F
<br />1,�A
<br />EACI OCCU;04,,', -E
<br />5,000,00C
<br />5,000,00€3
<br />X D 10,000
<br />WORKERS COMPENSATION AjN0
<br />WCA0200018131 01101120 01/01/2011
<br />%
<br />X U! i_
<br />uOu . 0"
<br />LO00100
<br />060 "06
<br />1,000,00
<br />�pllrlollwl Liabi I i ty/
<br />I, c: A S; ;E POL I C L I t, I T
<br />ECPCO20000413,: 11/16/2009 1 11/16/2010 1
<br />000,00
<br />E&O (claims made)
<br />$1,000 000 total
<br />limit
<br />m it &
<br />POLLUTION LIAR
<br />Annual Agg S/T S25,060 Ded
<br />OCC FORM)z
<br />0:::
<br />OESCRIPTiON OF OPERATIONS LOCATION s,, VEHICLES I EXCLL)Sto� ADDED By ENCORSEMENT f SPECIAL PROVISIONS
<br />'HE CITY OF SANTA ANA, ITS OFFICERS,
<br />DDITIONAL INSUREDS WITH
<br />AGENTS, VOLUNTEERS AND EMPLOYEES ARE NAMED AS
<br />RESPECT TO ALL 308 OPERATIONS PERFORMED BY THE NAMED INSURED. THIS
<br />NSURANCE IS PRIMARY TO ANY INSURANCE,
<br />EXCEPT 10 DAY NOTICE OF CANCELLATION
<br />FOR NON PAYMENT OF PREMIUM,
<br />SHOULD AIIYOF THE ABOVE DESCRIBED PO,,cjfiS BE CANCELLED BEFORE. TI-E
<br />"
<br />-.P.RA." DATE THEREOF, THE ISSUING INSURER WILL *UX�16 4AIt
<br />D
<br />CITY OF SANTA ANA DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
<br />20 CIVIC CENTER PLAZA M-93
<br />SANTA ANA, CA 92701 KAXX x x x x X)o
<br />ACORD 25 (2001108)
<br />IDACORD CORPORATION 1988
<br />
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