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-??? BAC KTON-01 DDIAZ <br />AcoRO- CERTIFICATE OF LIABILITY INSURANCE ° 10;11/2012 <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 palicy(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 />cert ificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />NAME <br />Chapman ^ ' - 20" - O S S - 0 O PHONE 1 626 405-8031 (A/C 1 405-0585 <br />a Division of Arthur J. Gallagher 8. Co. rv (A/c, No E:ry (.. _ ) _ {A/c, No): (626) <br />Insurance Brokers of California, Inc. E MAIL <br />PO Bo. 5455 ADDRESS_ <br />Pasadena, CA 91117-0455 New YINSURER(S) AFFORDING COVERAGE ork Marine ' and General Insurance Com s NAIL n <br />wsuRERA Non rofits Insurance Alliance of California 011845 <br />INSURED INSURERB P y,1660$ <br />Back to Native Restoration INSURER c <br />PO BOX 6539 INSURER D <br />Irvine, CA 92612-6539 - - I <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 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES S. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS' 5 1,000,OOO <br />INS -- -- POLICY EFF POLICY M - <br />?. LTR TYPE OF INSURANCE INSR?WVD POLICY NUMBER MM/DD/WYY <br />LIMITS <br />_(L (M <br />GENERAL LIABILITY M/OO/YYYV) EACH OCCURRENCE <br />A X COMMERCIAL <br />CLAIMS-MADE X LIABILITY X 201221765NP0 101112012 10/1/2013 k ..MACE TO RENTED <br />1 PREMISES {Ea occurrence) $ SOO,000 <br />CLAIMS- GENERAL L ? MED EXP (Any one person) $ 20,000I <br />OC CUR <br />`.PERSONAL &ADV INJURY $ 1,000,OO0 <br />GENERAL AGGREGATE h $ 2,000,00011 <br />GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,0001 <br />I I <br />III <br />POLICY PRO- <br />JECT LOC <br />AUTOMOBILE LIABILITY COMBINED BINED SINGLE LIMIT <br />1,000,000 <br />A ANY AUTO '.20122176SNPO 10/1/2012 10/1/2013 BODILY INJURY(R' -p1111,1-1) <br />ALL OWNED S( HFJULED - 1 <br />AUTOS <br />X S <br />N ON OVJNED Oacc tlentU RY P dr: rt) $ <br />AUTOS PROPERTY DAMAGE <br />HIRED AUTOS X <br />J <br />OCCUR EACH OCCURRENCE <br />I --- <br />UMBRELLA LIAB CLAIMS-MADE <br />EXCESS S <br />AB j -- - I? AGGREGATE <br />DED L-1 RETENTI $ <br />. OTH-'i $ <br />AND EMPLOYERS' COMPENSATION A LITYN$ <br />WO ORY LAMTS. I ER <br />B ANY PROPRIETOR/PARTNER/EXECUTIVE --2012131.0004.4 10/26/2012 <br />E.L EACH ACCIDENT <br />OF MaF'ntl ER a[o/E I. MB ER R EXCLUDED? Y / N N / A' 10/26/2013 - 5 1 r000000? <br />' <br />EL DISEASE - EA EMPLOYEE S 1,000,006 <br />Dyes. describe under i EL DISEASE -POLICY LIMIT 1 $ 1,000,000 <br />DESCRIPTION OF OPERATIONS U=!r?w T <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Atlditlonal Remarks Schedule if more space i required) III <br />` <br />Re: Use of City Premise at 600 E. Memory Lane, Santa Ana, CA 92705. The City of Santa Ana, its officers, employees, agents and volunteers are namey, <br />l <br />additional insured with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insurance is primary and O Tt VRXi <br />non-contributory per the attached endorsement. en <br />1 <br />I'I A44Rp?? ? oR?K i <br />Sp, Et p't?oCn?y <br />CERTIFICAT_E_ HOLDER CANCELLATION ?S tar's G? <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE RE? <br />The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERE IN <br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92702 - - - 1 <br />AUTHORIZED REPRESENTATIVE <br />I. <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD