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yV -Z aiv - /?? <br />?R?? DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE O <br />AP <br />2 D <br />M <br />P <br />1 01 24 11 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Leonard Adams 2nsurance, Snc _ HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />5201 SW Westgate Dr, Suite 300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Portland OR 97221 <br />Phones 503-296-0077 Fax: 503 -296-0044 INSURERS AFFORDING,COVERAGE NAIC# <br />INSURED <br />'` -? <br />INSURER A: Maryland `Ca`stial l?izs CrJ / <br />19356 <br />ttt??? ?) ( <br />? <br />N??o / ? irv ]( INSURER B <br />Ma 1n $Olut 10II5 2nC ((ll <br />1 INSURERQ ' <br />^ <br />19 <br />4 A Mol al la AVa <br />Oregon City OR 97045 INSURER D: 7 , ? ? "; <br /> <br /> INSV RER E: <br />COVERAGES <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 ISSV ED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SVCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IFS <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/1'Yl'Y DATE MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, O O O <br />A X COMMERCIAL GENERAL LIABILITY PPS43008706 02/06/11 02/06/12 PREMISES Ea occurence $ 1, 000, 000 <br /> 7 CLAIMS MADE ? OCCUR MED EXP (Any one person) $ 1 O , O O O <br /> ____ PERSONAL 8 ADV INJURY $ 1, 0 0 0, Q O O <br /> GENERAL AGGREGATE $ 2 0 0 0 O O O <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , O O O , O O O <br /> X POLICY PRO <br />JECT LOC <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE L <br /> IMIT <br />E <br />id $ 1, 000, OOO <br />A X ANY AUTO PPS43008706 02/06/11 02/06/12 ( <br />a acc <br />ent) <br /> <br />- ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> X HIRED AUTOS '? <br />? x <br />? a ? ? ? <br />D <br /> qh _ <br />?? <br />?` <br />J ? ?? ?? ngRY <br />? $ <br /> X NON-OW NED AUTOS ?-v?i <br />3` <br />' r <br />accide <br />( <br /> <br />I X Hired Auto Ph s <br />- y / <br />?/? <br />Q?? <br />PROPERTY DAMAGE <br />1 -- !? ?? ____. -_ Per <br />id <br />t $ <br />_ Damage $50, 000 _. -.-_---._._.__. ( <br />acc <br />en <br />) <br /> GA <br /> <br />-.__ RAGE LIABILITY ???_- )_;1Uit hl.'?l ---? -' - <br /> <br />' <br />' <br />' <br />AUTO ONLY - EA ACCIDENT <br />$ <br /> ANY AUTO tisial:?" <br />R: 1 <br />:.. <br />1 ', : \ <br />( ?-? EA ACC $ <br /> . OTHER THAN <br /> <br />AUTO ONLY: qGG __ - <br />$ <br /> EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ S, 0 0 0, O O O <br />A X? OCCUR ?, CLAIMS MADE pPS43008706 02/06/11 02/06/12 AGGREGATE $ 1, Opp, 000 <br /> <br /> DEDUCTIBLE <br /> X RETENTION $ O $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS' LIABILITY ,, / N _ TORY LIMITS ER _ <br /> <br />ANY PROPRIETOR/PARTNER/EXECUTIV <br />OFFICER/MEMBER EXCLUDED? ? <br /> <br />EL EACH ACCIDENT ___ __ <br /> <br />$ <br /> <br />(Mandatory In NHj <br />If <br />d <br />ib <br />tl <br />E.L. DISEASE - EA EMPLOYEE ___ <br />$ <br /> escr <br />yes, <br />e un <br />er <br />SPECIAL PROVISIONS below ----- <br />E.L. DISEASE -POLICY LIMIT ---- <br />$ <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />The City of Santa Ana, it's officers, agents and employees are additional <br />insureds as required by written contract_ <br />CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL <br />City of Santa Ana IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />20 Civic Center Plaza (M-29) <br /> <br />PO Box 1 9 8 8 REPRESENTATIVES_ <br />Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE <br />?. ? <br />saL.UKU z5 (2009/0'1) ©1988-2009 ACORD CORPORATION- All rights reserved. <br />The ACORD name and logo are registered marks of ACORD