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OP ID: PC <br />ACO/2 <br />_ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DONYYY) <br />? 10/01/10 <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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and contlitions of the policy, certain policies may require an entlorsemant. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER f)26-4OS-S 031 CONTACT <br />NAME: <br />Chapman B2B-4OS-O$HS PHONE.__. _. -_ - ___ _. FA% - - ___. - __. <br />? <br />License #0522024 SA/C, No)_ _-- <br />MAILO E t]=_ _ _ - ___. __ _ _._ _ <br /> <br />P <br />O_ Box 5455 ADDRESS _ ____ _-- _ _ - <br />- <br />- <br />. <br />Pasadena, CA 91117-0455 Plxoou cER <br />OCHUM-1 <br />cu?TOM ER to x,.___. , _ ___. _. _ __ -. _ _ _ <br />HOUSe_AGGOIInf ____ __-. ______. __.._ -_. -_-_ _ -_ _.--. --. ____ ___--_-_.___. INSURER(S?AFFORDING COV ERAGE _ NAICY <br />INSURED OC Human Relations COU nCII INSURERA:EVerest NatlOnal 10120 <br />1300 S. Grand Ave., Bldg B <br /> <br />Santa Ana, CA 92705 INSURER e : <br />--- --------_. ... ._ - ---- __..__ ------. _._. <br /> INSURER C _ <br />? -- _ <br />-- <br />- ?- <br />- <br /> _ <br />INSURERD <br />- <br />j _ <br />_ <br /> INSURER E <br /> INSURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER• <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 ANV 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />__ <br />INSR _-- - --- - - - -- -_-- ADDL SUBR - <br />LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP <br />LIMITS <br />MM/DD/YYVY MM/DD/YYYY <br /> GENERAL LIABILITY _ __ <br />EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY <br />_-- _ I <br />I p?gIAOiE T6 RENTED ? - <br />PREMISES SEa om rrenc 1 -- - <br />$ <br /> CLAIMS-MADE ? - J OCCUR MED EXP (Any me person) $ <br /> ____ __ _ __ i _PERSONAL B_ADV INJURY $ _ _ <br /> r_ _ _. -. -_ _ __ GEN ERAL AGGR EGATE $ <br /> ?_GEN'L AGGREGATE LIMIT APPLIES PER: <br />? ? O"? <br />F? PRODUCTS -COMP/OP AGG <br /> <br />- _. ? - - _ - _. $ <br />_ <br />__._.. <br /> PRO- <br />POLICY _ <br />T LOC T? <br /> AUT OMOBILE LIABILITY Rp COMBINED SINGLE LIMIT <br /> <br />F '?pp <br />+` ?/? <br />?-?" <br />(Ea accitlent) $ <br /> ? ANY AUTO j <br />? -_ <br /> r _. i <br />// <br />t%Jp <br />(?Y/ K BODILY INJURY (Per person) $ <br /> <br /> <br />? <br />ALL OWNED AUTOS <br />V <br />l <br />E <br />A <br /> <br />-?pRG - <br /> <br />BODILY INJURY (Per acdtlenl) <br />- <br />$ <br /> i SCHEDULED AUTOS `?S AttOrn <br />t - - - <br /> I ? istant C y DAMAGE <br />O $ <br /> 4 - HIRED AUTOS Ass I <br />(Pe <br />r acadanl <br /> <br />f---- NON-OWNED AUTOS ^ <br />l <br />_____ - __. __ $ <br />_. ___. ___-_-. <br /> / <br /> UMBRELLA LIAB OCCUR <br />__ EACH OCCURRENCE $ <br /> <br />__. EXCESS LIAB CLAIMS-MADE <br />_ __ _ _ AGGREGATE _ _ $___ _ _ _ <br /> DEDUCTIBLE <br />$ <br /> RETENTION $ g <br /> WORKERS COMPENSATION WC STATU OTH <br /> AND EMPLOYERS' LIABILITY ./ / N IQRY Llhl1T? _ ER - _. _ ___. -__.- <br />A <br />? ANY PROPRIETOR/PARTNER/EXECVTIVE r- 1 <br />OFFICER/MEMBER EXCLUDED? J <br />N / A 6600000739101 10/01H0 10/01H1 EL EACH ACCIDENT <br />(- -. <br />-- - $ 1,000,000 <br />- - <br />-- - ?- <br /> (MantlatorylnNH) ? EL DISEASE EA EMPLOYE $ 1,000,000 <br /> If yes, tlesQibe untla -- - --- -- ___ -- -- - -- - <br />_ DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT ? $ 1,000,000 <br /> _- __ <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Atltlltlonal Remarks Scbatlula, if more space is raquiretl) <br />Re: Dispute Resolution Program. 1 O days notice of cancellation for <br />non-payment of premium. <br />?.clcl Irlasa Ic nvl_u cr< GA NGtLLAI IUN <br />CITYSAI <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Clty of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, M-37 <br />Santa Ana, CA 92701 -4OSH A(U?T?H O?RIZ?ED?RE_PRESEN TATIVE <br />i \?L+"`-? `? - <br />©1968-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD