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`??c°? °? CERTIFICATE OF LIABILITY INSURANCE ??3i/ZO zw' <br /> <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 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 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. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT Susan Remeika <br /> NAME: <br />The Empire Company PHONE (714) 836-9945 q/C No: ('119)836-9996 <br />550 Parkcenter Drive E-p AIL .sremeika@empire-co. com <br />5111 tE 205 INSURER 5 AFFORDING COVERAGE NAIC # <br />Santa Ana CA 92705-3521 INSURERA:RE ublic 2ndemnit Com an 43753 <br />INSURED <br />INSURER B <br />Ameri care Respiratory $e:rV1 CE9 INSURERC: <br />1920 E Deere Ave Suites 110 INSURERD: <br /> INSURER E <br />Santa Ana CA 92705 INSURERF: <br />COVERAGES CERTIFICATE NUMBER:2012/2013 WC only REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOl WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE A S BR <br />POLICY NUMBER POLICY EFF <br />MM/DD/YY`/Y POLICY EXP <br />MM/OD/YYYY <br />LIMITS <br /> GENERAL LIABILITY <br />EACH OCCURRENCE <br />S <br /> COMMERCIAL GENERAL LIABILITY DAMA N <br />PREMISES Ea occurrence <br />$ <br /> CLAIMS-MADE ? OCCUR MED EXP (Any one parson) S <br /> PERSONAL S ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS -COMP/OP AGG $ <br /> POLICY PRO- LOC $ <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />Ea accitlent <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS BODILY INJURY (Per accitlent) $ <br /> HIRED AUTOS NON-OWNED <br />AUTOS PROPERTY DAMAGE <br />Per acdtlent $ <br /> <br /> UMBRELLA LIAe OCCUR EACH OCCURRENCE S <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br />jj WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY X WC STATU- OTH- <br /> Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />? <br />" <br /> <br />N/A <br />E.L. EACH ACCIDENT <br />$ 1 OOO OOO <br /> OFFICER/MEMBER EXCLUDED <br />) <br />(Mandatory In NH) 181215-02 1/1/2012 1/1/2013 E.L. DISEASE - EA EMPLOYE $ 1 000 000 <br /> If yes, tlescribe untler <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 1 000 000 <br /> <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD '10'1, Atldl[lonal R¢marks $cb¢tlule, i! more space Is raqulrad) <br />City o£ Santa Ana <br />Attn: Purchasing Dept. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />ACORD 25 (201 O/OS) <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 />1 Condy/SUSAN Jil G?-???? 4?-?? <br />©'1988-20'I O ACORD CORPORATION. All rights reserved. <br />INSD25 rvm nnsl nt Tho Af_flR rl .+?ma o..N 1??? oro rurv,?fe ruN mar4c r.f Af:fl Rrl <br />Exhibit C