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<br />accrrrc' CERTIFICATE LIABILITY INSURANCE
<br />�+---�"
<br />D06/0612 Y013Y)
<br />06/06123
<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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain poNcles may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsemen s .
<br />PRODUCER Phone: 888-762-3143
<br />CONT
<br />Veterinary Ins. Services Co. Fax: 916-921-2266
<br />CA License #OF64180
<br />1400 River Park Drive, 4180
<br />Sacramento, CA 95816
<br />Kathy R. Noe, CPCU, ARM •VP
<br />-NAME::
<br />PXOON o Inrc wa
<br />:LIMP L
<br />EMAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: Fireman's Fund Insurance Co.
<br />INSURED Community Veterinary Hospital
<br />William A. Grant II, DVM
<br />13200 Euclid Street
<br />INSURER B:
<br />INSURER C:
<br />—
<br />Garden Grove, CA 92843
<br />INSURER D:
<br />INSURER E
<br />AZ000878785
<br />INSURER F
<br />10/09/2013
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />J
<br />INNER
<br />TYPE OF INSURANCE
<br />ADOL
<br />SLOP
<br />POLICY NUMBER
<br />MMIDONYYY
<br />M°%D�/VYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />X
<br />AZ000878785
<br />1010112012
<br />10/09/2013
<br />pR M9ES Eaoccurmnm $ 100,00
<br />MED EXP (Any one Person) $ 10,00
<br />PERSONAL B ADV INJURY $
<br />GENERAL AGGREGATE $ 2,000,00
<br />EGATE
<br />GEN'L AGGRLIMIT APPLIES PER:
<br />PRODUCTS -COMI AGG $ 1,000,00
<br />Emp Ben. $ 1,000,000
<br />POLICY PRO LOC
<br />AUTOMOBILE
<br />LIABILITY
<br />OMBBIINEDtSINGLE LIMIT $ 11000,00
<br />BODILY INJURY (Per person) $
<br />A
<br />ANY AUTO
<br />AZC80878785
<br />10/01/2012
<br />10101/2013
<br />_
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY IPer acoidenn $
<br />PROPERTY DAMAGE $
<br />Per accitlent
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />$
<br />X
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,00
<br />AGGREGATE $ 6,000,00
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AZC80878785
<br />10/01/2012
<br />10/01/2013
<br />DEO RETENTION 3
<br />S
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? F7
<br />(Mandatory In NH)
<br />NIA
<br />W2P81006793
<br />10/0112012
<br />1010112013
<br />XWOCTTANS OER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00
<br />If yyes describe under'-"''—
<br />rt
<br />--- —'--
<br />E.I.. DISEASE -POLICY LIMIT $ 1,DOO,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AHaeb ACORD 101, Addhional Remarks Schedule, ITmore apace Is required)
<br />The certificate holder is named as additional insured �j�(y'�7ED AS•'�O FORM
<br />30 Days Notice of Cancellation/10 Days NOC for non-payment
<br />**Certificate holder continues: its officers, employees, agents, volunteers
<br />�iTc
<br />-�,
<br />and representatives.
<br />Laura A. Rossini
<br />Assistant City Attorney
<br />CITYSA3
<br />City of Santa Ana, *'
<br />Santa Ana Police Dept. - M18
<br />Attn: K9 Unit
<br />60 Civic 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 />All riehts reserved
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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