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-??1 BACKTON-01 PATRA4 <br />ACO/?O" DArE ?MM/DD/vwY) <br />CERTIFICATE OF LIABILITY INSURANCE 10/5/2012 <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 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 />cert ificate holder in lieu of such endorsement(s). <br />(PRODUCER CONTACT <br />'Chapman - PHONE -- 1 405-8031 - -- FAX - -- <br />a Division of Arthur J. Gallagher & Co. (A/a, Nps. Eat (626) J (A/o, No) 1 (626) 405-0585 <br />Insurance Brokers of California, Inc. E-MAIL - -- <br />PO BOX 5455 ADDRESS: <br />Pasadena, CA 91117-0455 INSURER(S) AFFORDING COVERAGE I NAIC # <br />INSURER A : Nonprofits' Insurance Alliance of California 011845 <br />INSURED INSURER B New York Marine and General Insurance Company 16608 <br />Back to Native Restoration INSURER C <br />PO BOX 6539 INSURER D <br />Irvine, CA 92612-6539 INSURER E - - I - <br />GENERAL AGGREGATE <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />_ <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 />, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED <br />PAID <br />CLAIMS. <br />INSR <br />? - - - <br />I LTR r TYPE OF INSURANCE _ <br />Iry$R A Sl1BR <br />-D - - <br />POLICY NUMBER <br />-- OL GV) <br />MM/DD/YYW C <br />Wj -- <br />-LIMIT5 <br /> <br />GENERAL LIABILITY <br />J <br />I EACH OCCURRENCE 5 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY X !201 221 76 5N PO 10/1/2012 10/1/2013 DAMAGE 70RENTE6 -- <br />PREMISES <br />E - - <br />000 <br />I $ 500 <br />I __ <br />( <br />a occurrence) , <br />CLAIMS-MADE X 1 OCCUR <br />I I MED EXP (An one n) $ 20,000 <br /> <br />4 <br />? PERSONAL 8 ADV INJURY 1 5 1,000,000 <br /> . - f $ 2,000,000( <br />GE <br />'L AGGREGATE LIMIT APPLIES PER PRODUCTS <br />COMP/OP AGG S 2,000,00011 <br /> <br />T <br />PRO- <br />POLCY JECT- LOC _ <br />--_ <br />LICY <br />J <br />I - <br />_ <br />I <br />AU <br />LIABILI <br />OM <br />TY <br />? <br />COMBINED SINGLE LIMIT <br />? <br /> <br /> <br />? <br />Ea accident <br />5 1.000.000 <br />1 <br />ANY AUTO 2011221765NPO 10/1/2012 10/1/201 3 ( person) <br />BODILY INJURY S -- <br />_ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS (Pe <br />r ac -`) <br />5 <br /> <br /> <br />X <br /> <br />HIREDAUTOS X NOgUN-OTOSWNED <br /> <br />r <br />( <br />ROPERTY <br />DAMAGE <br />Per accltlent <br /> <br />- <br />g <br />- <br />?. 1 I <br />UMBRELLA LIAB OCCUR <br />( ' - EACH OCCURRENCE $ <br />EXCESS LIAB 1 l <br />MADE AGGREGATE 5 <br />DED RETENTIONS <br />- 5 <br />WO <br />RKERS COMPENSATION - - - -- - -- - - - r --- - - WC STATU OTH <br />AND EMPLOYERS' LIABILITY Y/ N <br />B <br />WC2 _ TORY LIMITS _ER _ <br />( <br />PROPRIETOR/PARTNER/EXECUTIVE <br />ANY 01100000404 10126/2011 10/26/2012 E L EACH ACCIDENT 5 1,000,000 <br />OFFICER/MEMBER EXCLUDED? J NIA <br /> <br />(Mandatory in NH) - , <br />EL DISEASE - EA EMPLOYEE <br />5 1,000,000 <br />DESCRIPTION OF OPERATIONS b <br />l <br />e <br />ow EL DISEASE - POLIICY <br />IMIT 1 5 1,000,000 <br />A (ABUSE 201221765NPO 10/1/2012 10/1/2013 L <br />Occurence/Agre ate 1,000,0001 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional R--- Schedule, if more spac¢ is raqui-, <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 named <br />additional insured with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insurance is primary <br />rt <br />non-contributory per the attached endorsement. Z? <br />( AS TD L <br />I . <br />ROVE? <br />II A <br />p4 <br /> <br />CERTIFICATE HOLDER \ yOA 'fOY ney^ - - <br />CANCELLATION \-????? <br /> , <br /> <br /> E <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE B ORE <br />The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELI ERED IN <br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92702 j <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo a re registered marks of ACORD