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<br />UUMVt.1 UP IU: AU
<br />�,.._ CERTIFICATE OF LIABILITY INSURANCE
<br />OATS (MMMDIYYYYI
<br />66,'06,2013
<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 />i 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: It the certificate holder is an ADDITIONAL INSURED, the poiicy(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 />cortificatei holder in lieu of such endorsamen s .
<br />PROOUCER Phone: 666.762.3143
<br />CONTACT
<br />Veterinary Ins. Services Co. Fax: 916.921-2268
<br />CA License #OF64180
<br />1400 River Park Drive, #180
<br />Sacramento, CA 95815
<br />Kathy R. Nos, CPCU,.ARM ,VP
<br />PHONE "--� FA
<br />c to X No)_
<br />e• AI
<br />A°OfiE�,S-'
<br />INSUREaiSt.AFFORDINGCOVERAGE
<br />NAICA
<br />INSURER A: Fireman's Fund Insurance Co.
<br />�W
<br />PA.4MIN E TO ahNI ons
<br />INSURED Community Veterinary Hospital
<br />William A. Grant 11, DVM
<br />13200 Euclid Street
<br />INSURERS:
<br />S 10,00
<br />INSURER 0:
<br />$
<br />`........
<br />GENERALAGGREGATE
<br />Gorden Grove, CA 92843
<br />INSURER O:
<br />LIMIT APPLIES PER:
<br />PRO- r —I LOG
<br />INSURER E:
<br />_.2,000,00
<br />$ 1,000,00
<br />EmW Ben.
<br />_
<br />INSURER F : —
<br />A
<br />AUTOMOBILE
<br />iI X
<br />nnVn0Af1Ei4 flp:RTIClftATP AU I104FRi REVIFU1N 0JUMRFR.
<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 />INSR T j
<br />TYPE OF !NSU
<br />POLICY NUMBER
<br />D YY
<br />MI�DM"
<br />LIMIT4
<br />A
<br />GENERAL LIABILITY
<br />X. COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MAOE. if X] OCCUR
<br />X
<br />C80878785
<br />10101/2012
<br />10101/2013
<br />EACH OCCURRENCE
<br />$ 11000,00
<br />PA.4MIN E TO ahNI ons
<br />S 100,000
<br />MED E%P (Any one person)
<br />S 10,00
<br />PERSONAL& ADV INJURY
<br />$
<br />GENERALAGGREGATE
<br />$
<br />_
<br />OEN'L AGGREGATE
<br />POLICY
<br />LIMIT APPLIES PER:
<br />PRO- r —I LOG
<br />PROD_UCTS-COMP/OP AGG
<br />_.2,000,00
<br />$ 1,000,00
<br />EmW Ben.
<br />$ 1.000,000
<br />A
<br />AUTOMOBILE
<br />iI X
<br />LIABILITY
<br />ANYAUTOAZCS0878785
<br />ALL OWNED SCHEDULED
<br />F
<br />HIRE D AUTOS X NON -OWNED NON -OWNED
<br />AUTOS
<br />11010112012
<br />10/01/2013
<br />COMBINED SINGLE LIMIT
<br />EAaccidonl
<br />& 1,000,00
<br />BODILY INJURY (Par porson)
<br />$
<br />BODILY INJURY (Par atopen)AUTOS
<br />8
<br />eTn DAMAGE
<br />$
<br />$
<br />A
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />ILI
<br />OCCUR
<br />CLAIMS MADE
<br />C80878785
<br />10/01/2012
<br />10/01/2013
<br />EACH OCCURRENCE
<br />5 5,000,00
<br />AGGREGATE
<br />!$ 5,000,00
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITYTO
<br />! ANY PROPRIETORIPARTNERMXECUTIVE YIN
<br />OFFICERIMEMBER EXOLUDE09
<br />(ManaetorY le NH)
<br />Ifyyas, tlAAGibe tido,,
<br />DESCRIPTIONOFOPERATIONSbm,
<br />'NIA
<br />WZPOIOO5793
<br />10101/2012
<br />10/01/2013
<br />X WC STATU- OTH-i
<br />2Y LI
<br />E.L. EACH ACCIDEN r
<br />S 1,000'00
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,00
<br />_-- '__
<br />EL DISEASE -PI LIMIT
<br />_
<br />_ -
<br />vs1,000,00
<br />-..
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANAeh ACORD In, AdCIUonal Remick, Sohelule, If more Apace 11 required)
<br />41he certificate holder is named as additional insured bai.�}il ��`� �'� RM
<br />30 Days Notice of Cancellation/10 Pays NOC for non-payment ,
<br />**Certificate holder continues: its officers, employees, agents, volunteers %�-
<br />and representatives.
<br />Laura A. Rossini
<br />Assistant City Attorney
<br />CITYSA3
<br />City of Santa Ana, **
<br />Santa Ana Police Dept. - MIS
<br />Attn: KS Unit
<br />60 Civio Center Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />ARM -VP
<br />ACORD 25 (2010105) The ACORD name and logo aro registered marks of ACORD
<br />
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