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<br />02/24112
<br />OP ID: SL
<br />ASR° CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 02 /24 DIYYYY)
<br />02124112
<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
<br />REPRESENTATIVE OR PRODUCER, INSURANCE
<br />CERT F CATOE HOLDER. CONSTITUTE A CONTRACpI ,1�TWEEN T,HE')4Sjl,�NG, INSURER(S), AUTHORIZED
<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 conditions of the policy, certain policies may require an endorsement Ai statdment on this certificate {l)7es not confer rights to the
<br />certificate holder in lieu of such endomement(s). 'cz
<br />PRODUCER 626 - 397 -4700
<br />United Agencies, Inc.
<br />CA License #0252636 626 -683 -7682
<br />525 Cordova, Suite 200
<br />Pasadena, CA 91101 -2552
<br />EFIG SchlydmPRODUCER
<br />g
<br />'."TACT Sue LareoA- United Agencies ,, IL
<br />PHONE FA%
<br />,vc Na San, 626 -204 -6989 ac No : 626- 683.7682
<br />E -MAIL
<br />ADDRESS: slarson@unitedagencies.com
<br />CUSTOMER ID #; E2G2.01
<br />INSURE S) AFFORDING COVERAGE NIIC I—
<br />INSURED e2g2, Inc.
<br />INSURERA: Hartford Casualty Ins. Co. .29424
<br />1822a a rte 66
<br />Glendora, CA 91740
<br />INSURER B:
<br />INSURER C
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />_
<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 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 />ADM
<br />SUBR
<br />POLICY NUMBER
<br />MWD
<br />POLICY E%P
<br />M0 LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S 2,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Ldkj OCCUR
<br />X
<br />72SBAUV1521
<br />05/15111
<br />05115112 pREMISES Ea occurrence S 1,000,00
<br />MED EXP (Any one person) $ 10,00
<br />PERSONAL B ADV INJURY I,S 2,000,00
<br />GENERAL AGGREGATE �'S 4,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMPIOP AGG!$ 4,000,00
<br />POLICY PRO- F LOD
<br />IECT
<br />I S
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIREDAUTOS
<br />'.
<br />I ♦ 1]pn I ,` n` Cp
<br />APPROVE "D AS 10
<br />i,,
<br />FORM
<br />BODILY INJURY (Per accidenq
<br />3
<br />PROPERTY DAMAGE
<br />(Per accdenl)
<br />S
<br />S
<br />NON- OWNEDAUTOS
<br />I
<br />ttt
<br />9
<br />$
<br />UMBRELLA LAB
<br />OCCUR
<br />Laura SIX SU'
<br />Udy
<br />EACH OCCURRENCE
<br />$
<br />EXCESS UAB
<br />CLAIMS -MACE
<br />Assistant City ALIOrney
<br />AGGREGATE
<br />S
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOWPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />f es describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />�
<br />;72WECJUW3/
<br />05115111
<br />05115112
<br />"CRY STATU-
<br />T RY LIMIT ER
<br />E. L. EACH ACCIDENT
<br />S 1,000,00
<br />ELOISEASE- EAEMPLOVE
<br />S 1,000,00
<br />E. L. DISEASE - POLICY LIMIT
<br />S 1,000,00
<br />I
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remade Schedule, If more space la required)
<br />The City of Santa Ana, its officers, employees, agents and volunteers are
<br />named as additional insured with respect to the General Liability arising
<br />out of the operations of the named insured, if required by written contract
<br />per blanket additional insured endorsement included with Business Liability
<br />form SS0008 04/05
<br />aUal -I
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2009109)
<br />CITYOFS
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />n 1oaRJnOe
<br />The ACORD name and logo are registered marks of ACORD
<br />All rinhfe rcanrvnd
<br />
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