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<br />ACCW " CERTIFICATE OF LIABILITY INSURANCE 2012
<br />DATE IYYYY)
<br />02
<br />2012
<br />08
<br /> /
<br />/
<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
<br />M
<br />h USA
<br />I CONTACT
<br />NAME:
<br />ars
<br />,
<br />nc. FAX
<br />PH
<br />1801 West End Avenue, Suite 1500 C No Ext : A
<br />/c No :
<br />Nashville, TN 37203 E-MAIL
<br /> ADDRESS:
<br /> INSURER(S) AFFORDING COVERAGE NAIC #
<br />008240--CAS-12-13 _ INSURER A : National Union Fire Ins Cc Pittsburgh PA 19445
<br />INSURED
<br />Central Parkin
<br />Cor
<br />oration New Hampshire Insurance Company
<br />INSURER B 23841
<br />g
<br />p
<br />Central Parking System Inc. INSURER C : Westchester Fire Insurance Company 21121
<br />240121 st Ave. South, Ste 200 INSURER D : Illinois National Ins Cc 23817
<br />Nashville, TN 37212 -
<br /> INSURER E
<br /> INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: ATL-003104407-03 REVISION NUMBER: 13
<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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />1?TR TYPE OF INSURANCE jADDLISU D
<br />INSR POLICY NUMBER MM/ D1YYYY MM/ D1YYYY LIMITS
<br />A GENERAL LIABILITY GL 4406528 07/01/2012 07/01/2013 EACH OCCURRENCE $ 1,750,000
<br /> X COMMERCIAL GENERAL LIABI
<br />ITY DAMAGE TO RENTED
<br /> L PREMISES Ea occurrence $
<br />
<br /> CLAIMS-MADE CI. OCCUR MED EXP (Any one person) $
<br /> X $250,000 SIR PERSONAL & ADV INJURY $ 1,750,000
<br /> X $2,000,000 Per Project/Loc Agg GENERAL AGGREGATE $ 15,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000
<br /> X POLICY 17 PRO !? LOC
<br />JEC $
<br />A AUTOMOBILE LIABILITY CA 4982896 (AOS) 07/01/2012 07/01/2013 COMBINED SINGLE LIMIT 2
<br />000
<br />000
<br /> Ea accident ,
<br />,
<br />$
<br />B X ! ANY AUTO CA 4982897 (MA) 07/01/2012 07/01/2013 BODILY INJURY (Per person) $
<br />A ALL OWNED
<br />AUTOS
<br />I SCHEDULED
<br />AUTOS
<br />CA 4982898 (VA)
<br />07/01/2012
<br />07/01/2013 1
<br />BODILY INJURY (Per accident)
<br />$
<br />
<br />HIRED AUTOS NON-OWNED
<br />AUTOS PROPERTY DAMAGE
<br />Per accident
<br />$
<br /> $
<br />C X UMBRELLA LIAB X OCCUR G22055999006 07/01/2012 07/01/2013 EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE''. AGGREGATE $ 10,000,000
<br /> DED X RETENTION $ 10,000 $
<br />B WORKERS COMPENSATION WC 043464442 (AOS) 07/01/2012 07/01/2013 X I WC STATU- oTH-
<br /> AND EMPLOYERS' LIABILITY
<br />TORY LIMITS R
<br />D Y! N
<br />ANY PROPRIETOR/PARTNER
<br />E
<br />E WC 043464444 (FL) 07/01/2012 07/01/2013 1
<br />000
<br />000
<br /> /
<br />X
<br />CUTIVE
<br />N
<br />ER EXCLUDED
<br />N/A: E.L. EACH ACCIDENT ,
<br />,
<br />$
<br />A ?
<br />(Mandatory ry in in N NH)
<br />Manda WC 043464443
<br />
<br />(CA) 07/0112012 07/01/2013 1,000,
<br />000
<br />E.L. DISEASE - EA EMPLOYEE $
<br /> (
<br />If yes, describe under
<br />1
<br />000
<br />000
<br /> DESCRIPTION OF OPERATIONS below ,
<br />,
<br />E.L. DISEASE -POLICY LIMIT ? $
<br />D WORKERS COMPENSATION & WC 043464445 07/01/2012 07/01/2013 SEE ABOVE SEE ABOVE
<br /> EMPLOYERS' LIABILITY (MA, ND, OH, WA, WI, WY)
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />City, its officers, employees, agents, volunteers and representative are included as additional insured with respect to the general liability where required by written contract. This insurance is primary and non-
<br />contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract.
<br />APPROVED As To omm
<br />U
<br />t•CLLA I IVIV
<br />City of Santa Ana As?i?l:Uif l jt : NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />• J
<br />Clerk of the City Council THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Plaza (M-30) ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Stephen R. Earp j ? L /e.
<br />U 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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