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-'?C°'?°? CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/vrvr) <br />10/01 /201 O <br /> <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 policy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require en endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />MARSH RISK 8 INSURANCE SERVICES CONTACT <br />NAME: <br />345 CALIFORNIA STREET, SUITE 1300 PNONE ac No <br />CALIFORNIA LICENSE NO. 0437153 E-MAIL <br />SAN FRANCISCO <br />CA 94 <br />0 ADDRESS: <br />, <br />1 <br />4 PRODUCER <br />A[tn: Gene Williams 415-743-8320 <br />19025 -BOND-WC-10-11 INSURERS AFFORDING COVERAGE NAIG # <br />INSURED TWin City Fire Insurance CO 29459 <br /> INSURER A : <br />BLX GROUP LLC Hartford Underwriters Insurance Com an <br />p ?' 30104 <br />777 SOUTH FIGUEROA STREET <br />SUITE 3200 INSURER B : <br />, <br />LOS ANGELES, CA 90017 INSURER c :Hartford Accident 8 Indemnity Co. 22357 <br /> INSURER D <br />/n' j N- Z ? j.0 _ 0? /d <br />? INSURER E <br />? <br />?l INSURER F <br />COVERAGES CERTIFICATE NUMBER: SEA-001706234-06 REVISION NUMBER: 1 <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 BV 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 />ILTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/OD/YYYY MM/ U/YYYV LIMITS <br /> GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br /> COMMERCIAL GENERAL LIABILITY A A N E <br />PREMI ES Ea occurrence <br />$ <br /> <br /> CLAIMS-MADE ? OCCUR MED EXP (An one person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> <br /> GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS -COMP/OP AGG $ <br /> <br />POLICY PRO LOC _ <br />$ <br /> AUT OMOBILE LIABILITY ? /? COMBINED SINGLE LIMIT <br />$ <br /> pp <br />T? FORyvi (Ea accitlenl) <br /> O D AJ <br /> N pRUV F' BODILY INJURY (Per person) $ <br /> A <br />L OWN <br />ED AUTOS Ap <br /> BODILY INJURY (Per eccitlenl) $ <br /> SCHEDULED AUTOS <br /> ? <br />? AMAGE <br />R $ <br /> HIRED AUTOS ' - <br />C Y tlent) <br />(Per a cl <br /> C <br />J?> <br />tiliLL <br /> NON-OWNED AUTOS L,aUtL <br />rneY $ <br /> City tl <br />anc $ <br /> -5lst <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ <br />A WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY 57 WE TU9541 (ADS) 10/01/2010 10/01/2011 X WC STATU- DTH- <br />B Y / N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br />? <br />N / A 57 WE TU9541 (TX) 10/01/201 O 10/01/2011 EL EACH ACCIDENT $ 1 •000,000 <br />G. OFFICER/MEMBER EXCLUDED4 <br />(Mandatory in NH) 57 WE TU9541 (CA) 10/01 /201 O 10/01 /2011 E.L. DISEASE - EA EMPLOYE $ 1 •000.000 <br /> H yes, tlescribe under 1 <br />000 <br />000 <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT , <br />, <br />$ <br /> <br /> <br />DESCRIPTION OF OPERATIONS / LOCATONS /VEHICLES (Anach ACORD 101, Atltlitional Remarks Schedule, If more apace fa required) '?^ <br />' <br />' <br />? <br />Evidence of Workers <br />Compensation coverage. - <br />r?e-:?:^? c <br />-r <br />.........._. .y <br />?, <br />CERTIFICATE HOLDER CANCELLATION ?-=? ?"` ' -v <br /> L_ ?? <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLI E CAIII?ELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTIC L B rVDIELIVERED IN <br />Attn: Bich Ta ACCORDANCE WITH THE POLICY PROVISIONS r-n, .p. <br />20 Civic Center Plaza M-17 <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br /> of Marah Rlsk 8 Insurance Services <br /> Gene Williams ? ?/?? <br />®988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD