ECHAN, BARBARA A. 2 - 2009 - Laserfiche WebLink

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AC.ORDTM. CERTIFICATE OF LIABILITY INSURANCE DATE SEP 1 09 Y) PRODUCER E.L.M. INSURANCE BROKERS, INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 2668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1990 E. GRAND AVE STE 210 CA LIC OD28706 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LIMITS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE EL SEGUNDO CA 90245 -1768 PHONE: 310 - 322 -1301 Agency Lic #: OD28706 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Lloyds of London AUTHORIZED REPRESENTATIVE RM �- - INSURER B. $ —_. BARBARA ECHAN 3056 MADERIA AVE COSTA MESA CA 92626 INSURER C: $ j INSURER D. INSURER E: GENERAL AGGREGATE COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICV NUMBER POLICY EFFECTIVE DATE MM /DD /YV POLICY EXPIRATION DATE MM /DD /VY LIMITS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE GENERAL LIABILITY NOT INCL EACH OCCURRENCE $ �.. I,. _�.. ( �.. �,�./ APPROVED AS TO F COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR AUTHORIZED REPRESENTATIVE RM �- - DAMAGE TO RENTED PREMISES Ea o rence _ $ —_. VIED. EXP (Any One Person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG. $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY AUTOMOBILE LIABILITY NOT INCL ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGk :! $ I a GARAGE LIABILITY NOT INCL AUTO ONLY - EA AC�115IENT, $ OTHER THAN - EA ACC $� ANY AUTO AUTO ONLY: AGO $ , EXCESS / UMBERELLA LIABILITY NOT INCL EACH OCCURRENCE $ OCCUR n CLAIMS MADE L. AGGREGATE $ $ DEDUCTIBLE ------..._----- ----- $ RETENTION $ - - $ WORKERS COMPENSATION AND NOT' INCL i,,, EMPLOYERS' LIABILITY ''. w S7AT LIMITS O R E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE '., 'i E.L. DISEASE -EA EMPLOYEE $ OFFICER /MeMBER EXCLUDED? '. It yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT - -- $ OTHER: PROFESSIONAL LIABILITY 0510- 001224036 MAY 1 09 MAY 1 10 $1,000,000 / $1,000,000 LIMITS /// A (CLAIMS MADE FORM) DESCRIPTION OF OPERATIONS /LOCATION /VEHICLES /EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE IS FOR PROOF Of PROFESSIONAL LIABILITY COVERAGE. NOTHING IN THIS CERTIFICATE SHALL ALTER, AMEND OR EXTEND COVERAGE PROVIDED BY THE ABOVE MENTIONED POLICY. CERTIFICATE HOLDER IS NOT ADDED AS AN ADDITIONAL INSURED TO THE REFERENCED POLICY. ALL OTHER TERMS AND CONDITIONS OF THE REFERENCED POLICY REMAIN IN FULL FORCE AND EFFECT. 05/01/2007 RETROACTIVE DATE.'10 DAYS NOTICE OF CANCELLATION IN THE EVENT OF CANCELLATION FOR NON - PAYMENT. /// CFRTIFICATF 1401 r1FR I I ADDITIONAL INSURED: INSURER LETTER: CAldCFI I ATInM CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 CIVIC CENTER PLAZA EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT SANTA ANA, CA 92702 -1988 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. �.. I,. _�.. ( �.. �,�./ APPROVED AS TO F AUTHORIZED REPRESENTATIVE RM �- - Attention: ACORD 25 (2001108) L• Certificat # 4126 Frederick J. Fisher 0607799 B N MIN KAUFMAN Chlef A 119t8flt City Attorney c s^^ L/ LJ