|
N-data - /l7
<br />
<br />^v ° CERTIFICATE OF LIABILITY INSURANCE `Y n
<br />;
<br /> 2011
<br />6/23
<br />THIS CERTIFICATE IB ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCAT
<br />E H HOLDER, THIS
<br />CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW, THIS CERTIFICATE
<br />CE
<br />INSURANCE
<br />TT? 5NRCT BETWEEN THE ISSUING INSURER?Sti AUTHORIZED
<br />ORPRODUCE ER, AND THE
<br />DEPTH ER.
<br />PEPRESENTA
<br />OR PROD
<br />IFI ER.
<br />IMPORTANT If the cefffmc holder Is an ADOMONA1INSURED, the PNlI must be eodoMed. If SUBROGATION IS WANED, subject to
<br />the WhIsand CoOmdOMs of the PMIW, InPC IIUIe R` Uluahs memo!kMMMeet aR this oedlfloak dose 00(MGnf01 tight, to the
<br />c(CL a holder AAMU OI suoh endorsemenhs)
<br />veWUCFR NINE, Nane Blucher 8obb Bacon
<br />
<br />P, 0, Box 12079 No EM , Arc No.
<br />
<br /> PBWfR
<br />t Msamt MOTIF
<br /> INSUR SAfFOR01NGWVRWF NNCa
<br />WYIfQD INSNAFAA',VeLle Tome IIIADCenCe PA, 20E08
<br />
<br />2127 Centre Point Blvd IrvsuRERa,American Cas,Ce,of Reading, PA 20427
<br />,
<br /> InsuAEeR.Transportation Ins. Com an
<br /> IreeAEAE; f
<br />
<br />
<br />IN60AFRF$aVPLPi6 CABllalt 6 Surety CO /on
<br />31194
<br />COVERAGES CERTIFICATE NUMBER: 199E96409f REVISION NUMBER:
<br />
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD INDICATED, NOTWITHSTANDING ANY REGUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS CERTIFICATE MAY BE ISSUED3 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br />TOALLTHETERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />INSR
<br />LiR RPEa NSURANCE
<br />POUCYNUMBFR POLCYEFF
<br />MMnefnYY POUCYEIP
<br />MMmn v
<br />LMIR
<br />A CFXGALLLAmun P Y ]09]190918 1/1/ialF PLl/2NR FALHaCUfPENCE ll,aea,Pee
<br /> X fQNIffRCIPLCFNERAIIIASUtt pgMSpg EMttUne? SID0, 000
<br /> CWMSMA[E 1XI OCCUR MEDIXPAMMrs {enml ls,NeN
<br /> X A%V RetlpP PERSDNALa40VWOFY 1LA00, 000
<br /> GEIfRAIAGCPEWFE yC,oOO, 00o
<br /> GFMAL[MECAIEIIMNIPPIIECFFR pimDm9NIIPpPpfG 92A00, 000
<br /> x PoUCY ?IOC !
<br />B W1 W0911E LL4BINY Y Y P2091E8)Sel 1/1/1011 1/1/2X12 CqJ&NF?9M1CdELIMT fit, 000,000
<br />
<br />'
<br />` (E+aW?ll
<br /> AM
<br />WIO ,. rl I) ?y, :
<br />Yi..?11 BDmIYINIUAY
<br />Pd
<br />^ I
<br /> I
<br />4dA
<br />I
<br /> A0.WMEONR09
<br />B7glYIWUAYPdaubM
<br />!
<br /> .YNF?UIEDWTOS f PRPEPfIWMAGE
<br />!
<br /> P NIFEDWIOS ? J.--- (Fg??
<br /> x NLNNWEOWICa "I !
<br />
<br />C M OMB#LLI WB X WOM P2091E6ea96 1/1/2011 1/1/2012 FACNfWUfWPILE 9SS, 000, 000
<br /> pCFbe LUB CWMSMP[E AGGREGAtE B
<br /> OF?LCIImE B
<br /> x PETENnoN Ela,aea !
<br />q W0
<br />ANa 51ERSWRPENBAPdN
<br />eMtt0YEA6'LUBlllrv Y 1011086n2 1/1L2N11 i/t/20t] % NG SiFTpDIH NXL-0elcx
<br />p yIN 101I086PAe CA 1/1/2011 P/t/pti
<br /> ANYPROPNENMARII?FXECNIVE
<br />NIA EL FACNPGSCEM SSOO,000
<br /> OfFICERmFAISER WAOCEID
<br />Mpn4kryln NX EL gSEPSEFAEIRIO 9100,000
<br /> Hyy?? ?auka,
<br /> CFSdMmONOFOPERUILNSMkw EL gSEPff CLR1'UYIi 9E00.000
<br />P Pmfeplonal Liablllry 1019681& P/1/toll P/L/2012 Pea Clalm 2,000,000
<br /> Clalme-Made POtm mgete Esosscs
<br /> 1LSL9S Retm Male; A?%IV
<br />[fetRIP11pNOFOPEPAlI0N51LOG110N51YFNICIFS WM?am0A0141,AEMIOnIWmuNSANUY,IImanpellnptlntll
<br />UmSrella, A-%V RadngAll Other Woekexs' Camp and CA WorkeeM' Comp , A-%V RAEing. California B1Aployere
<br />Liahility Lindts: $1, 000,400 Saeh Accident?$1, 000, 000 Disease Policy Limit?$1, 000,000 Oiseaee 2SCh
<br />Earl Bacon Agency, Inc. reoxE
<br />Tallahassee FL 32717 p oAlwfas. hbacon®earlbacoacom
<br />MGT of An'Eriea, Inc.
<br />Tallahassee PL 72708 InsuRFRm,COntinenLal Casualty Cam an 20447
<br />employee
<br />?AN?[LLRIRIrI
<br />I"jCANLryp
<br />City of Banta Ana, At[n.:-WA-b-Hayes-
<br />20 Civic Centex Plaaa {FF3B?' /.P,p7
<br />P, 0, Box 1988
<br />Santa Ana G 927021988
<br />
<br />ACORD25 ?20DSIDR) TheACORD Mameaod logo are regutmed make olACORD
|