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A-200- <br />ACC>Ra CERTIFICATE OF LIABILITY INSURANCE <br />4 <br />THIS CERTIFICATE IS MWED AS A [LATTER OF WFPRPAMON ONLY Alto WW * Tia"H RIPM, DIPQN 'am C . ,..,, <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NMW*IELY AMEND, EXTEND OR ALI" THE COVHSRlW►►� - IIY THE POLICIES <br />SILOW. THIS CQtTI KATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE MMNG iNVAUMM AUTHORIZED <br />REPRpE11TATIVE OR PRODUCER, AND THE TF NQLPEN. <br />IMPO . I oertMcate InWa S an TN the Po )must sft t0 <br />tee Mme and conditions of the Policy, certain Policies may require an aldcrsama7L A statement on Ids owellca o does not confer reds to the <br />De11McO h"r In Lea Of seal endorsurm t(sL <br />PINOl1OEt <br />The <br />Dlvietal ofSta9 Rmk <br />95 CrawAays Paris Drive, P.O. Baas 9917 <br />ty, KY 11787 <br />THE MM "M DATE TNOtMW, NOTICE MLL as DWVWM N <br />X117 <br />a <br />Ira Aefa D e ! RR waea <br />ROUMAAM <br />Empkryee Benefits M34 J Attn: Kethy gook <br />eaLow REACK3 <br />Reach Employee Assistance, Ina <br />Dr. Mama Dayhoff <br />880 NOM ROM Drve SM <br />Placentia, CA 92870 <br />Aunna®REmasENTATWE <br />P.O. Box 19M <br />c; <br />f: <br />COVE!"Is CEFCIi= w2M OW14M <br />NDICATI D WYMIPHETTANDMAKY REO,t4S9!Mt1T, S%Iti fii:Qt1.OF <br />CERTIFICATE MAY BE ISSUED OR MAY PP7ttAN, TI1E E AFFORDED <br />EXCLUSIONS AND OONDM NS OF SUCH PQI,Iy"W UNITS.. ' MAYHAVESEEf <br />ANY .Q BK TO WHICH THIS <br />SY THE TO ALL THE TERNS, <br />TIPEDFMNUrArIQ <br />tams <br />494MALL&ANAY <br />CeeeA®ICL,L O&J ;RAWN L1rY <br />O.WAS#MDE OOCCUR <br />Y <br />N <br />UN 149W <br />7IIOt4 <br />EACH OCCLWFRNM <br />si <br />S1040110 <br />N ®DQ2 w000pw3wo <br />f <br />PFft,90IALdAOVNAAY <br />81100111,0110 <br />GENOMAGGREGAM <br />"In. AGGREGATELa1R PtR: <br />PG.nCY LAC <br />PRODUCTS- COM%OPAao <br />h <br />a <br />AUTOMONi LI MRY <br />ANY AUTO <br />ALLOYMED AMW <br />HIRED 903 PSCMB>AW <br />A Ay a <br />t <br />SMY M.URY rwpv9 ) <br />f <br />BDMY MARY 0P epddeda <br />nw <br />a <br />i <br />L ••ma, a UAS <br />EMMLLAS <br />OCCUR <br />ClAM1fMAOE <br />eRCN OOMMMM <br />i <br />AGGREGATE <br />: <br />i <br />NO <br />ANY rael.OY OFJPARTt4r'Y <br />O am"DAMEXMLMMfJEQJnVl Yr'1 <br />a waWyl"MtF7a:LlAEDI iruf <br />Mpe <br />U s. MPAMMrePERATioN5 bear <br />NIA <br />Y A <br />El. EACH ACCOQfr <br />i <br />EL DaEASE- lEAE/iL0 <br />f <br />ELDNEASE- MXYLMR <br />s <br />ProheMenelt <br />Y <br />tAerAe <br />7/[014 <br />7fM1a <br />Eeeh Yleldelt 51.004000 <br />AEV"ae 55004000 <br />OOGFnCN OF OPBUTIONf tLOCATMMI VEKCM 01eed1ACORD 101, Adtpm! Reneb sAfldMe, aeenAPeah nofta <br />Cfty of Sams Ana is inducted as additional insured WXh respeGS to wont peromled by, or on behalf of the Named Insured. <br />CANCELLATION <br />CERTIFICATE HOLDER <br />SHOULD ANY OF THE MOVE OMMMM POLNM M CANCELLED BEFORE <br />THE MM "M DATE TNOtMW, NOTICE MLL as DWVWM N <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVMDNL <br />Empkryee Benefits M34 J Attn: Kethy gook <br />Aunna®REmasENTATWE <br />P.O. Box 19M <br />Santa Ana, CA 92702 -1988 <br />®1588-2019 ACORD CORPORATION. AI rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />