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(7nmmpri-bi C;ertifiritp of Tnsnranrp <br />04/11/2011 08:56 17147313808 <br />INSURANCE AGENCY <br />V A D AI C D C- <br />03473 P.001 /001 <br />5e.2492 4{ 4 Copy llistribution: Service Center Copy and Agerits Copy <br />Fax from : 17147313886 04/11/11 <br />H41 <br />18:48 Psi: 1 <br />Commercial Certificate of Insurance <br />FARM s R5 <br />icy , ALLINSON INSURANCE AOF,NCY <br />8/11 <br />Name . 14151 NEWPORT AVE #101 <br />2Jjj Pj�Y —1I "3 (MWDD/YY) 04i <br />L <br />& • TUSTIN, CA 92780 <br />only arnd Nrskrs n0 tlglit5 <br />Address . 714 838 2860 <br />"Thb certifip[e is isued as a matter of infcrcmtio <br />_ <br />upon the ontQaie tWlii'r- This cealticam does <br />amend. extend or alter do <br />St. 97 DCSL �' Agent 323 <br />coverage afinrded hV!the Policies shown below. <br />�:_ L. .- <br />. <br />Companies ProvltCmg <br />Coverage <br />Insured <br />i�°`aP ° ^Y A Tmcl:Insuar!ec Esc";" <br />. THE PETERSON GROUP <br />Name . #2 CORPORATE PLAZA DR. 150 <br />�ty*y B Fanners Insurance <br />�hmnge <br />& . NEWPORT BEACH, CA" 92660 <br />C—,rranv C Mid - Century haaaa <br />ce Company <br />Address <br />D <br />cry <br />nt(^nC " <br />` <br />Coverages <br />�— <br />This is to certify that the policies of insurance listed below have <br />boss issued to the imiued named above for the policy period <br />icated. Notwithstanding <br />any requirement. term or condition of any comsat-: or ocher doormen wirh respect to which this certificate may be issued or 1�ay <br />pertain, the ifuutance <br />afforded by the poll= described herein as subject to all the terms, eacl®om and conditions of such policies. Limits shows may <br />have been reduced by <br />paid claims. <br />Ur. <br />Type of Insurance <br />Policy Number <br />Polity MwDD <br />Date <br />� fm <br />Ceiva-altB87egur <br />y Limits <br />E <br />General Liability <br />._...i <br />Comowoal General <br />Produce -Comp <br />Aggfer: <br />YS <br />3 <br />Orcurrerce Vernon I <br />Advertising l*'D' <br />I <br />S <br />Cdmaractual - Incidental I <br />Each Oa.7trreree <br />$ <br />i <br />Onh, <br />Fire DanrW <br />ca gel <br />E <br />Owners & Contractors Prot- <br />Medical <br />Medal <br />(Any out pal <br />- <br />3 <br />Automobile Ua biky <br />Combined Sing <br />ALL Owned Commercial <br />LIMA <br />Autos . <br />Bodily Injury <br />i <br />Scheduled Auto <br />I <br />(Papuson) <br />S <br />Hired Autos <br />- <br />Booty 1111 <br />(Per as:ddentl <br />S <br />Non -Owned Autos <br />Gaze I talai ily <br />Property Danaai� <br />$ <br />Gaardeee PWepir <br />$ <br />- <br />_... -__. <br />Umbrellaliabiity <br />MIE <br />A <br />i Wtlrkess'CompensaUOn <br />A01097222 <br />04!11/11 <br />04/11/12 <br />EachAcy <br />ach ddesn <br />I <br />.3 1,000,000 <br />and <br />Employers' Uablllty <br />Disease - Ex" taiee <br />$ 1,000,000 <br />Disme _ pokey <br />Park <br />3 1,00(1.000 <br />Description of Opentlnrtc /VeMdes/Re&mctiorm/Special ltem <br />\PPROvEo AS 'I'O FORM <br />i <br />Certificate Holder <br />CanceilaGoni -aura Suit Site y <br />. CITY OF SANTA ANA <br />Should any of dlaabeac d+§'m rApbfiafsitx �ancelit�' <br />pekte the expiration date <br />Name . 20 CIVIC CENTER PLAZA <br />th®mL the issuing mmpany will endeavor to mail 30 <br />wftm notice to the <br />& • SANTA ANA, CA- 92701 <br />certificate holder named to the W but failum to <br />bilty of arty kind the company. <br />aaia notice shall impose no <br />amrs � Mrtm- <br />Address <br />Mg <br />or . <br />AuMMzed Represilintative <br />5e.2492 4{ 4 Copy llistribution: Service Center Copy and Agerits Copy <br />Fax from : 17147313886 04/11/11 <br />H41 <br />18:48 Psi: 1 <br />