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C <br />t , <br />1`4'o CERTIFICATE OF LIABILITY INSURANCE <br />DATE2 /30 /20 OYYY) <br /># <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />INSURER A: ACE American Insurance Company <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />INSURER B: Indemnity Insurance Co of North America <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />INSURER C: Zurich American Ins Co <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />INSURER D: <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />m <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />INSURER F: <br />Tan RFVIQICIN NIIMRFR- <br />certificate holder in lieu of such endorsement(s). <br />d <br />PRODUCER <br />CONTACT <br />'O <br />PHONE FAX <br />(AIC. No. Ext): (866) 253 -7122 Alc. No.: (847) 953 -5390 <br />Aon Risk Services south, Inc. <br />Atlanta GA Office <br />3565 Piedmont Rd NE,Blgl, #700 <br />O <br />E-MAIL <br />Atlanta GA 30305 USA _ <br />PRODUCER 570000039630 <br />" <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE <br /># <br />INSURED <br />Sapphire Technologies, LP <br />(See Attached Named Insured Schedule) <br />60 Harvard Mill Square <br />Wakefield MA 01880 USA <br />ar, u■000. c7nnn IOOA <br />INSURER A: ACE American Insurance Company <br />226667 7 <br />INSURER B: Indemnity Insurance Co of North America <br />43575 <br />INSURER C: Zurich American Ins Co <br />16535 <br />INSURER D: <br />INSURER E: <br />GLO <br />INSURER F: <br />Tan RFVIQICIN NIIMRFR- <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 MAY 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. Limits shown are as requests <br />INSR LTR <br />TYPE OF INSURANCE <br />ADD <br />INSR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMI DDIYYYY <br />LIMBS <br />C <br />GENERAL LIABILITY <br />X C OMMERCIAL GENERAL LIABILITY <br />GLO <br />EACH OCCURRENCE <br />$5,000,000 <br />DAMA C' <br />PREMISES Ea occurrence) <br />$1,000,000 <br />MED EXP (Any one person) <br />$10,000 <br />CLAIMS -MADE X❑ OCCUR <br />PERSONAL 8 ADV INJURY <br />$5,000,000 <br />X Contractual Liability <br />GENERAL AGGREGATE <br />$5,000,000 <br />PRODUCTS - COMP/OP AGG <br />$5,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO LOC <br />0' <br />AUTOMOBILE <br />LIABILITY <br />/ <br />1 0 0 <br />0/01/201 <br />COM SINGLE LIMIT <br />Ea aBINED t <br />cciden <br />$2,000,000 <br />X <br />ANY AUTO <br />% <br />BODILY INJURY ( Per person) <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />HIRED AUTOS <br />NON OWNED AUTOS <br />M <br />,� * <br />1� =• CR j� �•W <br />Deputy City Auorney <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />EXCESSI <br />CLAIMS -MADE <br />DEDUCTIBLE <br />RETENTION <br />B <br />A <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/ PARTNER I EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? [ <br />(Mandatory in NH) <br />NIA <br />WLRC46139811 <br />WLRC46139793 <br />SCFC4613980A <br />10/01/2010 <br />1010112010 <br />10/01/2010 <br />10 /01 /2011 <br />10/01/2011 <br />10/01/2011 <br />X TORY SMTTS ERH <br />'- <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />, <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND <br />REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH REGARDS TO LIABILITY AND DEFENSE OF SUITS ARISING FROM THE OPERATIONS AND <br />USES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED PER ATTACHED CG2010 FORM. <br />• <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />CITY OF SANTA ANA AUTHORIZED REPRESENTATIVE <br />ATTN: LORI SMITH <br />1439 S. BROADWAY <br />SANTA ANA CA 92707 USA �zri�/J ✓y/ <br />01988 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />Z6 <br />V <br />N <br />N <br />O <br />LO <br />O <br />Z <br />A <br />V <br />w <br />d <br />0 <br />ti <br />■ <br />