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;,-._ <br />F ??? <br />?,t ? .?? <br />'`??°R°? CERTIFICATE OF LIABILITY INSURANCE Ros4 <br />?? o4TEi?/°ZOi2 <br />THIS CERTIFICATEIS 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 ADDITIONALINSURED,the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to <br />the terms and 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 endorsement(s). <br />PRODUCER CONTACT <br />NAME: <br />CJN INSURANCE SERVS CES/PHS <br />135212 P <br />(866) 467 <br />8730 F <br />877 A/OC NNp Eat: (866) 467-8730 laic, Np7: (877) 905-0457 <br />: <br />- <br />: ( <br />) 905-0457 <br />PO BOX 3 3 O 15 E-MAIL <br />ADDRESS: <br /> <br />SAN ANTON20 TX 78265 PR U <br />cusroMERID#: <br /> <br /> INSURER(S) AFFORDING COVERAGE NAIC # <br />/NSUREO ' - INSURER A SeRt.1R21 =215 CO LTD <br />P2GS TASL USA LLC AND PRO-CON <br />SNDUST INSURER B <br />RSES SNC . <br /> <br />1601 E SANNT ANDREW PL INSURER C <br /> <br />SANTA ANA CA 9 2 7 0 5 INSURER D <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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAV 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 />LTR TYPE OF /NSURANCE <br />/NSR <br />WVO <br />POL/CY NUMBER POL/CY EFF <br />/MM/00/YYYY/ POL/C EXP <br />/MM/00/YYYY/ L/M/TS <br /> GENERAL L/AB/L/TY <br />EACH OCCURRENCE <br />3 2 O O O O O O <br /> COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) 9 1, O O O, O O O <br />A CLAIMS-MADE ? OCCUR MED EXP (Any one person) 3 1 O , O ? Q <br /> X General Liab X 51 SBA AD7666 01/18/2012 O1 ?1R/2013 PERSONAL&ADV INJURY 9 2, OOO? 000 <br /> GENERAL AGGREGATE 9 4, 0 0 0, O O O <br /> <br /> EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG 3 4, 0 0 0 r O O O <br /> PRO O <br /> POLICY ? <br />LOC - ? - 9 <br /> AUT OMOB/LE L/AB/L/TY <br />- COMBINED SINGLE LIMIT <br />3 <br /> ANV AUTO IEa accident) 2, 0 0 0, O O O <br /> <br />ALL OWN BODILY INJURY (Per person) 3 <br /> ED AUTOS <br />SCHEDULED A BODILY INJURY )Per accident) 3 <br /> <br />A UTOS <br />PROPERTY DAMAGE <br /> X HIRED AUTOS 51 SBA AD7666 01/18/2012 01/18/2013 <br />)Per accident) 3 <br /> X NON-OWNED AUTOS 5 <br /> 3 <br /> UMBRELLA L/AB OCCUR <br />` f? <br />? "I?/? <br />EACH OCCURRENCE <br />3 <br /> EXCESS L/AB CLAIMS-MADE Appgp?J <br />$ja A v <br />TO +'? AGGREGATE 3 <br /> D EDVCTIBLE <br />9 <br /> RETENTION 9 <br />s <br /> WORKERS COMPENSAT/ON 1 <br />i SA <br />? <br />O <br /> ANO EMPLOYERS' L/AB/L/TY <br />, ` TORY L MITS <br />ER <br /> ? <br />/ N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE sistant Ci <br />A y Attorney <br />? <br /> OFFICER/MEMBEREXCLUDEDP ? N/A . <br />s / E.L. EACH ACCIDENT 3 <br /> /Mandatory in NH/ <br />E.L. DISEASE - EA EMPLOYE <br />3 <br /> If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />S <br /> <br />OESCR/PT/ON OF OPFRAT/ONS /LOCAT/ONS / VEH/GLES /A ffach ACORO f01, Add"bona/ Ramarhs Schadu/a, if more space is reOpired/ <br />Those usual to the 2nsured's Operations- Certificate Holder is an Additional <br />Snsured per the Business Liability Coverage Form 550008 attached to this <br />policy <br />CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />City of Santa Ana BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />Attn - Purchasing Dept DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />2 0 C 2 V I C CENTER PL Z AUTHOR/ZED REPRESENTAT/VE ` <br />SANTA ANA , CA 9 2 7 01 ??_ ?Q_?(4,?? <br />® '1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />Exhibit C