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OP ID: NR <br />'��,�'`r`� CERTIFICATE OF LIABILITY INSURANCE <br />DAIE(MM /DOIYYYY) <br />05!31111 <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(iea) must ba endorsed. If SUBROGATION IS WAIVED, subject to <br />the farms arld conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endoreem am s <br />PRODUCER 419 - 255 -1020 <br />Hyle nt Group Inc - Toledo <br />911 Madison Ave 419 - 255 -7557 <br />Toledo, OH 43604 <br />Jeannie Y_ Hylant <br />C�ACT <br />PHO� FAX <br />,� No A/c No <br />PEi WAftESS� <br />o c R ERODE -3 <br />CUSTOMERID <br />PJSURER(S AFFO ROING COVERAGE <br />NAIC f <br />INSURED Jay Broderick dba Mad Science <br />of West Orange County <br />3501 W. Moore Ave. Ste J <br />Santa Ana, CA 92704 <br />INSURER A: Philadelphia Indemnity Insr Co <br />16056 <br />INSURER B: <br />INSURERC- <br />INSI.IRER D <br />EACH OCCURRENCE <br />INSURER E: <br />A <br />INSURER F <br />X <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. NOTWITHSTAN D9VG ANY REQUIREMENT, TERM OR CON DffION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMJDDIYVFYY <br />MMIDU� <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LWBILITY <br />X <br />PHPK624505 <br />10/15!10 <br />10!15111 <br />300.00 <br />PREMISES Ea occun'ence <br />$ <br />MED EXP (My one person) <br />E '15,00 <br />CLAIM:-, -MADE � OCCUR <br />)( Abuse/MolestaRion <br />PHPK624505 <br />10/15/10 <br />10!15!11 <br />PERSONAL &ADV INJURY <br />$ 1.000.00 <br />GENERAL AG GREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE <br />LIM 17 APPLIES PER. <br />PRODUCTS - COMPlOP AGG <br />$ 2.000.000 <br />POLICY <br />PRO LOC <br />if. M <br />$ 500.00 <br />AUTOMOBILE <br />LIAB�ITY <br />COMBINED SIN GLE LIMIT <br />(Ea acaaenry <br />t 1,000,000 <br />A <br />ANY AUro <br />PHPK624505 <br />10115H0 <br />10!15/11 <br />BODILY IN JURY(Per person) <br />$ <br />ALL OWNED AUTOS <br />BODILY IN JUR'r (Per acatlen[} <br />$ <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE <br />x <br />HIRED AUTOS <br />(Per acciaenU <br />$ <br />X <br />NON - OWNED AUTOS <br />� <br />$ <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />� <br />EACH OCCIRRENCE <br />$ <br />EXCESS LIAB <br />CLAIMSJNADE <br />�. <br />� <br />AGGREGATE <br />$ <br />D EDIJCTIBLE <br />�' <br />$ <br />$ <br />R ETENTION <br />WORKERS COMPENSATON <br />ANOEMPLOYERS'LIABILITY <br />� ` <br />GJ�4e' <br />WC STATU- OTH- <br />TORY LIMITS ER <br />Y!N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEM6ER EXCLUDED? � <br />N / A <br />IIr�v <br />V <br />�' <br />,SOS <br />�' <br />. P <br />E.L. EACH ACCIDENT <br />$ <br />(Mantlalory In NH) <br />S <br />4� <br />��`� <br />If yes, Gescnbe under <br />EL DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS below <br />P' J�a <br />DESCRIPTION OF OPERATIONS! LOCATONS / VEHCLES (Atlaell ACORD t01 AEtlltlonal Renlalka Sen etlule, Ir more apace Is requlraE] <br />City of Santa Ana Parks, Recreation, 8 Community Services Agency Hs <br />officers agents, employees, representatives and volunteers are Included as <br />an Addltlonal Insured par Form CG201 O. <br />_ _ _ �- - -- - — —��� 4..liJY,..CLLfi 11Vry <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATON DATE THEREOF, NOTCE WILL BE DELNERED IN <br />Cily of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Silvia Cuevas <br />26 Cfvlc Center Plaza AUTHORIZED REPRESENTATNE <br />Santa Ana, CA 92701 <br />O 1988 -2009 ACORD CORPORATION. All rights reserved. <br />.+.-.. rcu co I�uuaiva/ The ACORD name and logo are registered marks of ACORD <br />