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Client #: 1258425 <br />304COMPUMGM <br />ACOR�,M CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM /DD /VYYY) <br />TYPE OF INSURANCE <br />9/06/201 1 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require apl'I¢�IdO{SB mle h2. A` §�ate3f1e�1[pn this certificate does not confer rights to the <br />� <br />certificate holder in lieu of such endorsement(s). � - � ' <br />PRODUCER <br />AME_ <br />668T Insurance Services � � I <br />PHOME 9493 8772971094 <br />c .NO Exe :.. , . A/c. No <br />of Orange County } _ <br />_, ✓ t <br />- -' <br />19100 Von Karman Ave. Ste 900 <br />- ADDRESS: '- <br />$1,000,UDD <br />Irvine, CA 92612 <br />CUSTOMER ID #: <br />PERSONAL 8 ADV INJURY <br />$1,000,000 <br />INSU RER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER A : OneB @aCOn Insurance Company <br />21970 <br />Compulink Mgmt Center Inc <br />$ <br />dba Laserfiche <br />INSURER B <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUT05 <br />NON -OWNED AUTOS <br />3545 N. Long Beach Blvd. #110 <br />INSURER G <br />02/13/201 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$1 X00 UDD <br />Long Beach, CA 90807 <br />INSURER D <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />INSURER E <br />x <br />INSURER F <br />$ <br />X <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MM /DD /YYW <br />PMM /DD /WYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />• <br />7110103310003 <br />2/13/2011 <br />02/13/201 <br />EACH OCCURRENCE <br />$1 X00 UDD <br />PREMISES Ea occurrence <br />$1,000,UDD <br />MED EXP (Any one person) <br />$10,000 <br />PERSONAL 8 ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO LOC <br />PRODUCTS - COMP /OP AGG <br />$2,000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUT05 <br />NON -OWNED AUTOS <br />7110103310003 <br />2/13/2011 <br />02/13/201 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$1 X00 UDD <br />X <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />x <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />X <br />$ <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />7110103310003 <br />02/13/2011 <br />02/13/201 <br />EACH OCCURRENCE <br />$2O OOO OOO <br />AGGREGATE <br />_ <br />$2O OOO OOO <br />DEDUCTIBLE <br />RETENTION <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY y / N <br />ANV PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/M EMBER EXCLUDED? � <br />(Mandatory In NH) <br />If yes, tlescribe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />4060200720004 <br />01/01/2011 <br />01/0'1/201 <br />X wcsTATU- oTH- <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1 ,000,OD0 <br />E.L. DISEASE - POLICY LIMIT <br />$1 000 DDD <br />A <br />Professional <br />Liabilit <br />7110103310003 <br />2/13/2011 <br />02/13/201 <br />Limit $5,000,000 <br />Deductible $25,000 <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schetlule, If more space Is required) - ,J � - � 1 <br />Evidence of Professional Liability coverage <br />l.1CK I Ir II.GA 1 C 1-IVLUCK <br />GANG EL CATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Attn- Bruce Fruchter <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />• <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />24 Civic Center Plaza M-42 <br />Santa Ana, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />`7S� - �� <br />®1988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S7409680/M6970392 MASUA <br />