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4 <br />ACC)RV CERTIFICATE OF LIABILITY INSURANCE / <br />`" <br />' <br />1% <br />3/11/201.1 <br />11 <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 CONSTJTU I A CONTRACT BETWEEN THE ISSUWG INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate hokkw Is an ADDITIONAL INSURED, OW policy(we) must be andoread. 9 SUBROGATION la WAIVED, subject to <br />the terms and conditbons of the policy, certain policies may require an endorsemeft A statement on this Cortlflcale does not confer rights! W the <br />Certificate holder in lieu of such endcn"mran s . <br />PRODUCER CONTACT John Joesph <br />...... <br />Premier One Insurance Services ? C949) 727-2025 PA. <br />rs?adnasT-s?zssf <br />100 Pacifica Star 480 <br />?AA0. <br />John josephePremierOne,oasl <br /> suaTOrER Ip i?0000t1b4 <br />Irvine CA 92618 wsuRgxl oROalaCOVSaoE i rurc. <br />INSUMV arswtwA Granite State Inavsainoe Congas 3809 <br /> <br />Ater, Inc. u?6IrReR B <br /> <br />1 Goodyear 100 nlsuRER c <br /> n?wrrER 0, , ,,, .. <br /> <br />Irvine CA 92618, 1 IN0111IFJ1 i ; <br />two <br />COVERAGES CERTIFICATE NUMBER:CL112901892 REM 911131111 NLIaaB@Rt <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. NOTIMTHSTANDINO 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 />wak, ... ..INWRA 4. .-....... -_..?AODL DlJlt.......____ ,.,..-----YNUYBEN <br />._._.._.,--_-._,,.,,......... <br />PbLJCrli'P...i._I'000.EIi?...i..._.. ...-----....___.UNITS <br />..GENERAL UANUTY I <br />I ?I <br />s !APES OCCURRENCE t <br />F <br />COMMERCIAL GENERAL LMXTY 7 1 OAI1AGE TO IiEFJli3} <br />as --___. ...,.... ._.-- <br />` ! CLAY6a,I11DE ., OCCUR ' <br />I i . <br />----------------------- <br />_ __ _ __ ; I <br /> <br />, i PErerrowv a ADV ranlRr a <br />_... <br />----` <br />_. <br />? <br />L---' ------ ------------- _.---. <br />i r <br />GENERAL <br />JKIGRE4ATE I f <br />OEWL AGGREGATE UMn APPLIES PER I PRODUCT6 • COI/PlOP AQG ? S <br />POLICY I LOC <br />NCT ! ....__-_._ -....__..r....... __- ..............,__...----.- <br />i AUTOMMI(A LIABILITY <br />i <br />3 <br /> lE+aootd?rah <br />ANY AUTO <br />-------------- <br />OOWLYINJURyfporwn) i 3 <br />- ? ALL OWNED AUTOS I ? ? -_ -•° --- - ..._ _ .. _.. _. <br />BODILY INJURY (P. acstlrq j S <br />SCHEIXILED AUTOS <br />L _.....__ _ - <br />° 1 PftOPE iY DAMAOE <br />HIRED AUTOS I ? IE ?l i <br />NON-OY"E-DAUT05 <br />------------- --_ + ...-.._ ............... <br />- <br /> .. <br />S <br />tWORELiA UAe <br /> <br />OCC0A <br />i....I <br /> <br /> <br />EAC11000URR,ENCE, ...I,},. . <br />EWAM L1Ae CLAIM64AADE i <br />I ._.......... - ' AGGREGATE is <br />oEDIXTWE <br />'. RETENTION S i <br />WONKMIS CONIPENGATIDN <br />A I I I <br />, ANO6MPlOYr9tS'LIAIILRY <br />: <br />YIN <br /> <br />ATU- i ?Crw; <br />, x <br />_ °.L4; <br />lORY1alI <br />FB <br /> <br />. <br />ANY PROPRIETOWA0tTNGbl7frCUTF& <br />N 1 A I <br />OFFICERMEM6ER FXCLLrDEC7 <br />(M-Adwy InN 001606518' <br /> <br />- <br />-- <br />. <br />I I E.L EAG1ACCaQENT a 1 IOQD, 000 <br />2/13/2011 /15/2012 <br /> DISEASE _EAEMPLO"AI$ 24 <br />wq 000 <br />2 <br />' D PTIO. OF IONS W _ <br />-._ <br />I <br />ow EL OISEA p - POLICY LOW! S <br />i <br /> <br />i <br />I <br />DEMINPTION Of OPERAT10N6 J LOCATIONS 1 VWCLES ?A4R,L ACORD 101, Abeeond MReIb ado", a can sp"w M hFinq) <br />-PL V V <br />vai21'i <br />3"0= ANY OF THE ABOVE DESCRIBED POUrA65 BtS CANC1fbJ.W BEFORE <br />Laura Stitt Skid THE EXPOtAT10N DATE TWREOP, NOTICE WILL BE DELIVERED ur <br />City of Santa Ana Assistant tit y AGCMAWAWITH THEPOLICY PROVISIONS. <br />20 Civic Center Plaza Y Attorney <br />Rosa Annex (M) AUTNORILED RIPRVIII?NJA <br />Santa Ana, CA 92701-4058 <br />r ? . <br />ACORD 215 (2009109) - 994$..21009 AC4 T10W. All riots re"rviet <br />IN30261 ww) The ACORD name and logo are reglsjpr W marM of ACORD