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-a► �� ® CERTIFICATE OF LIABILITY INSURANCE <br />DATE IMM/DD-1 <br />•wRM <br />08/13/2010 <br />PR LICE <br />ST T I SURANCE - JOHN LUITHLY <br />16 71-�y CANYON RD STE F <br />LR 618-4011 <br />THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURERA: Slate Farm General insurance Company 25151 <br />25151 <br />_ <br />INSURERS: State Farm Mutual Auto Insurance Company 25178 <br />ELIZABETH M KILEY INC <br />DBA KILEY COMPANY <br />2661 DOW AVE STE E <br />INSURERC-State Farm Fire and Casualty Company 25143 <br />INSURER D' <br />TUSTIN, CA 92780-7244 <br />INSURER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />ADD'L <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MM/DD/YY <br />POLICY EXPIRATION <br />DATE (MM/DD/YY) <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY <br />Ti5N <br />PREMISES Ea occurrence $ <br />MED EXP An one rson $ <br />CLAIMS MADE [�] OCCUR <br />PERSONAL S ADV INJURY $ <br />— <br />GENERAL AGGREGATE $ <br />GENT AGGREGATE LMIi APPLES PER <br />PRODUCTS -COMP/OPAGG E <br />PRO- <br />POLICY JECT LOC <br />B <br />X <br />AUTO <br />MOBILELIABILITY <br />ANY AUTO <br />085 9537-801-75C <br />2008CADILLAC CTS <br />08/01/10 <br />02/01/IL <br />COMBINED SINGLE LIMIT <br />(E... itlen) <br />— <br />BODILY INJURY g 100, 000 <br />(Par Person) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />1G6DR 57V7 8 0 154 516 <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY g 300,000 <br />(Per —d—) <br />MP DED — 500 <br />acci­d­)PROP dR )AMAGE $ 100, 000 <br />(Per <br />X <br />LL <br />CODED - $500 <br />GARAGE LIABILITY <br />AUTO ONLY — EA ACCIDENT S <br />OTHER THAN EA ACC E <br />ANY AUTO <br />AUTO ONLY_ <br />AEG $ <br />A <br />X <br />EXCESS/UMBRELLA LIABILITY <br />75—CD-249'3-7 G <br />08/02/10 <br />08/02/11 <br />EACH OCCURRENCE $ 1, 000, 000 <br />AGGREGATE g <br />OCCUR = CLAIMS MADE <br />E <br />DEDUCTIBLE <br />D AS TO <br />FORM <br />$ <br />RETENTION S <br />APPROV <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />WC LIMIT O TH- <br />TORY LIMITS ERR <br />ANY PROP R IETOWPARTNE R/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />If yes, tlescribe untlar <br />a <br />EL EACH ACCIDENT $ <br />ra S tl tt Shee <br />E.L. DISEASE - EA EMPLOYEE $ <br />SPECIAL PROVISIONS below <br />ALL <br />ne <br />E . DISEASE - POLICY LIMIT $ <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />CERTIFICATE HOLDER __ ___ <br />CANCELLA I ION <br />jAdditional Insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />CITY OF SANTA ANA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />PUBLIC WORKS AGENCY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />20 CIVIC CENTER PLAZA — ROSS ANNEX REPRESENTATIVES. <br />SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE <br />JOHN LUITHLY <br />132849 <br />hts <br />