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a"baa? & a_ c,1 .7/ c. V11 _L Z. . V.]. J12 1-1'1 r['fv L:. L/ VVG VCLA oGl YUA <br />'°'`°RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) <br />F02/09/2011 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />TH S ECRTIFICATE F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EN THE S N R( A H DIED REPRESENTATIVE <br />OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poiicy(les) must beIra ed. if SUBROGATION AIVED, subject to tho <br />terms and conditions of the policy, certain policies may require an endorsement. A staten this certificate dCet confer rights to the <br />certificate holder in lieu of such endorsement(s). rl EL: <br />AUTOMATIC DATA PROC INS AGCY INC PHONE FAX <br />677-0424 Ac No : b7 677-04 30 <br />PRODUCER VPRODUCER NAME: <br />71 HANOVER RD <br />A / d avelora.com <br />FLORHAM PARK, NJ 07932 <br />(877) 677-0428 i? 0 /0 / Oz 655)D6126 <br />XV770 70A INSURER(S) AFFORDING COVERAGE NAIC • <br />INSURED INSURER ATRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br />CONSENSUS, INC INSURER B: <br />626 WILSHIRE BLVD. #1000 INSURER C: <br />LOS ANGELES, CA 90017 INS[IRFR it <br />I INSURER F: I I <br />rrnviceArMcc rrcoTtctrrerc rJI tAA@CC• nnaao aonodoi ndn REVISION NURARFR- <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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NSR <br />TR <br />TYPE OFINSURANCE ADD <br />INSII BUBR <br />Vfvn <br />POUCY NUMBER POLICY EFF <br />(MMIDDNYYYI POUCY EXP <br />NMND ryyyy <br />LIMITS <br /> GENERAL LIABIrr1' <br />EACH OCCURRENCE <br />? <br /> COMMERCIAL GENERAL LIABILITY DAMAGE T071f? $ <br /> CLAIMS-MADE 7 OCCUR M XP An one person) $ <br /> $ <br /> PERSONALa ADV INJURY <br /> <br /> GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG <br /> <br /> <br />j F-1 <br />El 'EC _ PRO <br />Loc <br />POLICY <br /> <br /> <br />S TO FO <br /> <br /> <br />M <br /> <br /> <br />$ <br /> <br />AUTOMOBILE LIABILITY <br /> <br />? COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br /> ANY AUTO v ( BODILY INJURY (Per person) $ <br /> ALL OWNED AUTOS <br /> <br />DAU <br />Laura titt Sheerly <br />BODILY INJURY (Per ecodem) <br />$ <br /> SCHEDULE <br />TOS <br />HIRED AUTOS Assistant City AttornL <br />Pa' ecCider AGE <br />$ <br /> NON-0WNFD AUTOS $ <br /> It <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> H DEDUCTIBLE $ <br /> RETENTION $ $ <br /> <br />A WORKERS COMPENSATION <br />' NIA UB-90810486-11 01/01/2011 01/01/2012 X STAT - OTH <br />LIM I, [ ER <br /> AND EMPLOYERS <br />UABIUTY YM <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ? E L EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1 ,000,000 <br /> li yes, descnbe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br /> <br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H morespece Is required) <br />CITY ATTORNEY <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA (M-29) <br />PO BOX 1988 <br />SANTA ANA, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE <br />WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE • Nd:f <br />40L a? <br />dfw? <br />®1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD