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ACORD, CERTIFICA <br />OF LIABILITY <br />INSURA E DATE80103Y1 <br />PRODUCER <br />626 - 275 -3000 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Golden Pacific Insurance <br />Services, Inc. <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />P. O. BOX 7045 <br />COMPANIES AFFORDING COVERAGE <br />Pasadena, CA 91109 -7045 <br />COMPANY <br />A Atlantic Mutual Insurance Co. <br />INSURED <br />Amrel Systems, LLC <br />L�n3 —OyH <br />COMPANY <br />B <br />American Reliance, Inc. <br />COMPANY <br />11801 Goldring Road <br />C <br />Arcadia CA 91006 <br />COMPANY <br />D <br />.�. �\llMli...... ,..... , <br />n. ..... .. wx .. .: un :.: <.� <n :n :pa :.,:. ✓ .... ..... .. ..............:.......... ..on.n. vn, n,:.n:.. . <br />n:, <br />,..,...x<[fp ..n ..:.:.:.:... . <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 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 />CO <br />LTR <br />TYPE OF INSURANCE <br />PODUY NUMBER <br />POLICY EFFECTIVE <br />DATE (MMMD/YY) <br />POLICY EXPIRATION <br />DATE IMM/DD/YVI <br />LIMITS <br />A <br />GENERAL <br />LIABILITY <br />7610068210001 <br />8/03103 <br />8/03/04 <br />GENERAL AGGREGATE <br />0 2000000 <br />X <br />PRODUCTS - COMP /OP AGG <br />$ 2000000 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE FRI OCCUR <br />PERSONAL & ADV INJURY <br />t 1000000 <br />EACH OCCURRENCE <br />0 1000000 <br />OWNER'S & CONTRACTOR'S PROT <br />FIRE DAMAGE (Any one tire) <br />0 1000000 <br />MED EXP (Any arse person) <br />B 10000 <br />AUTOMOBILE <br />UA &UTY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />F <br />BODILY IN9 <br />(Par person) ) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per acclEeml <br />9 <br />HIRED AUTOS <br />NON-OWNED AUTOS <br />PROPERTY DAMAGE <br />$ <br />GARAGE UABIUTY <br />AUTO ONLY - EA ACCIDENT <br />1 <br />OTHER THAN AUTO ONLY: <br />ANY AUTO <br />EACH ACCIDENT <br />AGGREGATE <br />9 <br />A <br />EXCESS LIABILITY <br />7610068210001 <br />8103/03 <br />8/03/04 <br />EACH OCCURRENCE <br />11 2000000 <br />X UMBRELLA FORM <br />AGGREGATE <br />B 2000000 <br />q <br />OTHER THAN UMBRELLA FORM <br />'HUNKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />I WC STATU- OTH- <br />TORY <br />EL EACH ACCIDENT <br />8 <br />THE PROPRIETOR/ INCL <br />PARTNERS/EXECUTIVE <br />EL DISEASE - POLICY LIMIT <br />0 <br />EL DISEASE - EA EMPLOYEE <br />L <br />OFFICERS ARE: EXCL <br />OTHER <br />AFp <br />AS <br />TO FORM <br />DESCRIPTION OF OPEMTIGNSA.00ATIONSNEHICLES /SPECIAL <br />ITEMS <br />Evidence of Insurance. <br />See attached endorsement. <br />R1 E LEE SHAW <br />p City Attorney <br />10 Da s NOC of non- a ment of premium. <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />Attn: Clerk of City Council <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />P.O. BOX 1988 <br />BUT FAIWRE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />Santa Ana, CA 92702 -1988 <br />OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. <br />ALTHOPo ENTA <br />%411`:81 y� ;xu):• 3 <br />................Y:[.k:. .......,..,: . f.:. i' �# �':. i [•f`i "'ii':`�......:[:)3i`Fi " "' isn:' o' �Ci�iiiu. Q:,: i.,..::["..:".' ii:;.: i�:;. ..:�:.:!,>:'•i:: <.`g..,)y...... .... .;.�..y..yy..��{{�y/�y� /y yy <br />