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Auk <br />AK <br />aCORV? CERTIFIMATE OF LIABILITY INSURANCE <br />F DATE <br />09/06/2011YY) <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 LIC #0551220 1-949-769-3108 CONTACT Millie Anderson <br />NAME: <br />Goodman Insurance Services PHONE 949-769-3108 FAX 949-769-3928 <br />(A/C, No, Ezt). (A1C, No): <br />114 Pacifica, Suite 430 ADDRESS millie@goodmaninsurance.com <br /> PRODUCER <br />Irvine, CA 92618 CUSTOMER ID p: <br />Justin Goodman INSURER(S) AFFORDING COVERAGE NAIC A <br />INSURED INSURER A: PRAETORIAN INS CO 37257 <br />Legal-Aid Society of Orange County <br /> INSURER B. <br />2101 N TUBtin Ave INSURER C: <br />Santa Ana, CA 92705 INSURER D: <br /> INSURER E : <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 22984517 REVISION NUMBER: <br />THIS IS Tn CFRTIFY THAT THE POLICIES OF INSURANCF I ISTFD 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 [HIS <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 />ADDL SUBR POLICY EFF POLICY EXP <br />TVPF OF INSURANCE <br />LTR POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS <br />GENERAL LIABILITY EACH OCCURRENCF $ <br /> DAMAGE TO RENTED <br />COMMEkCIAL. GENERAL LIABILITY PREMISES (Ea occurrence) $ <br />CLAIMS MADE OCCUR MED EXP (Any one person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ <br />POLICY EO LOC $ <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> $ <br />(Ea accident) <br />ANY AUTO <br /> HODII Y INJURY (Per person) $ <br />At I OWNFD AUTOS <br /> BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS <br /> PROPERTY DAMAGE <br />HIRED AU IOS (Per accident) $ <br />NONOWNED AUTOS $ <br /> <br />UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br />EXCESS LIAB CLAIMSMADE AGGREGATE $ <br />DEDUCTIBLE $ <br />RETENTION S $ <br />A WORKERS COMPENSATION AQW003188 09/01/11 09/01/12 X WCSTATU- OTH- <br />AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER <br />ANY PROPRIETORIPARTNERIEXECUTIVE - EL EACH ACCIDENT $ 1,000,000 <br />OFFICER!^AEMHER EXCV1nED9 NIA <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000 <br />Ii yes, describe wider <br /> <br />DESCRIPTION OF OPERATIONS below <br />El DISEASE -POLICY LIMIT $ <br />1,000,000 <br /> <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Proof of Insurance. <br />I.CR I IrI4,A 1 C r1VLLI CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />CDBG M-25 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Community Development Agency <br />PO Box 1988 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />USA <br />0- - <br />N <br />c <br />rV <br />oc <br />?n <br />u <br />Igoodman © 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />22984517