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ACORO CERTIFICATE OF LIAB1LITi' INSURANCE <br />�� <br />OATEILI a/D DIYYYY) <br />6/25/2012 <br />THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT dFFIRMATIYELY OR NEGATIVELY AMEND, E %TEND 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 polley(les) must be endorsed. if SUBROGATION IS N /RIVED, subject to <br />tlTO terms and conditions of the policy, certain policies may requlro an entlorsement. A statement on this certificate does not confer rights Lo the <br />certificate holder In Iteu of aucl) entlorsomen s . <br />PRODUCER <br />MOC 2nsuranca Sarvi cea <br />License No. 0569960 <br />44 Montgomery $t. , 17 tY1 F1. <br />San Franoisco .CA 94104 <br />NTA T DOrina da FabiO <br />NAME: <br />F NE (415) 957 -0600 . /a1s)ssT -osTT <br />e' .ddafabioCmaroavioh. aom <br />INSURERS AFFORDING COVERAGE <br />NAICI <br />INSUaeRA �{artford Casualt Ina. Co. <br />9424 <br />1NBV RED - <br />K ©year Marston Asaooiates, Inc. <br />55 Paoif io AvenuEa Ma11 <br />San Francisco CA 94111 <br />INS a a:Har_tford <br />1$2'2 <br />INSUneRCRa ublio Indemnit Com an nP <br />2179 <br />INSUNeRD Mt. Haw1a Insurance Co. <br />A <br />INSURER E <br />X <br />INeu e <br />7UUNPV0563 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMF_NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WF11CH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDIT)ON3 OF SUCH POLICIES. LIMITS 8HOWN MAY HAVE BEEN REDUCED BY PAID CiLAIMB. <br />LTR <br />TYPE OF IHSV RANCE <br />POLICY NUMBER <br />EFF <br />POLICY gXP <br />LINITe <br />GENERAL 4A01YTY <br />EACH OCCURRENCE <br />1,000,000 <br />A <br />X COLMIERCULL GENERAL LIA6LHY <br />CLAMS -MADE OOCCUR <br />X <br />7UUNPV0563 <br />12/1/2.111 <br />2/1/2012 <br />F_ E <br />S 300, 000 <br />MEO EXP cne can <br />$ 10 000 <br />PERSONAL 6ADV WJURY <br />E 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />o Daduotibl0 applies <br />GENL AGGREGATE <br />X POLICY <br />LIMB APPLIES PER: <br />PRO- LOC <br />PRODUCTS - COIAP /OP AGO <br />$ 1 , 000 , OOO <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />X ANY AIfTO <br />AUTOS NED nG�OEDULED <br />X HIRED AUTOS X NON- OYJNED <br />AUTOS <br />X <br />7VWPV0563 <br />- <br />2/1 /2D31 <br />2/1/2012 <br />OA98 (dE I <br />1 000 000 <br />BODILY INJURY (PU person) <br />E <br />BODILY INJURY (POf 9ccklenl/ <br />$ <br />PROPE D <br />acc <br />E <br />X COMP 5500 X Cetl 65CD <br />- <br />�red et cornbtned <br />E 1 000 000 <br />X <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCV RRENCE <br />$ 4,000,000 <br />B <br />EXCEBg LIAR <br />CLAMI B -MODE <br />X <br />71UtOPV0506 <br />2/1/2011 <br />2/1/2012 <br />AccREOATE <br />E 9,000,000 <br />X 10,00 <br />S <br />C <br />YJORKER9 COMPENSATION <br />AND EAIPLOVERS• LIABIDTY <br />ANY PROPRIETORIPARTN ER/EXECirTNE Y/N <br />OFFlCER/MFASBFR EXCLU DED7 � <br />(NyyeUeaa,.d.alory In NH) <br />DESCRIPTION OAF OrPERAT10Ng below <br />N/A <br />39546 -17 <br />2/1/2011 <br />2/1/2012 <br />X NC ST OTH- <br />E.L EACH ACCIDENT <br />6 1 OOO OOO <br />E -L DSEASE-EA EMPLOYE <br />E 1 000 000 <br />EI_ DISEASE - POIJCY LgdR <br />9 1 000 000 <br />D <br />pro £aaaiOnal Liability <br />0- 848728 <br />2/1/2011 <br />2/1/2012 <br />EACH NRONOFVL AGT $1,000,000 <br />Ra tantion: $50,000 <br />atro Data 10/05/1976 <br />AGGREGATE LIMIT S$, 000, 000 <br />DESCRIPTION OP OPERATLOHS /IOCATONa /VEHICLE$ (ARach ACORD f01, Addttlenal Remarks gcMdWe,hman specs Nrequlud) <br />CortiFioata holder Tha City oP Santa Ana, its offioara, employees, agents, volunteers and reprbaentativas <br />era Additional Insured with reapeata to the Tnaurad's. operations. Insurance provided is Primary and is <br />not oontribvtory with any other insurance serried. 30 Day Notice oP Cancailation /10 Day for non payment <br />of premium. <br />P OVER R5 TO Fnn�n <br />VMnI V,CLW IIViY <br />r� ! <br />SHOULD ANY OF THE ABOVE DESBR POL1d1A�BE ��K4 Lt:QD•SEd�)�E � <br />THE EXPIRATION DATE THEREOF, NOT`¢ES`t�(),fyjt �ELIYE RED IN <br />City o£ Santa Ana ACCORDANCE WITH THE POLICY PROYI510f1'J1$$55 <br />Executive Direotor of PSA <br />2D C1 ViC Cant ®r Plaza AYn /0R250 REPRESENTATNE <br />Santa Ana, CA 92701 ^ `'• <br />Donna da Fabio /DDS yG�iwv�,o�_�y \� <br />ACORD 26 (2070/06) - ®7968 -20'10 ACORD CORPORATION. All rights reserved. <br />INS026 (2oloos).ot The ACORD name and logo are registered marks of ACORD <br />