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�� <br />'i. ' , CERTIFICATE OF LIABILITY INSURANCE <br />D/8/2 I13 Y) <br />5/8/2013 <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 />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 <br />Ambassador Group Inc. <br />7010 E Chauncey Ln - <br />Ste 230 <br />Phoenix AZ 85054 <br />CONTACT Laurie SCola <br />NAME: <br />PHONE AX <br />(480) 776-6950 AAA No. (480)996-6951 <br />E-MAIL SS, lscola@ambassadorins.com <br />ADDRE <br />INSURERS AFFORDING COVERAGE <br />NAIC4 <br />INSURER A:Continental Casualty Company <br />20443 <br />INSURED -*160 ® dig "�t ® <br />Card Meter Systems Inc. dba CMS dig <br />J <br />7056 Archibald Ave Ste 102-453 <br />Corona CA 92880 <br />INSURERB:Valle Forge Insurance Com an <br />20508 <br />INSURER C: <br />_ <br />INSURER D: <br />INSURER E <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER:13-14 Master REVISION NHMFSPR <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 <br />LTR <br />TYPE OF <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDIYYYYI <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 11000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 5Z OCCUR <br />4025961553 <br />5/1/2013 <br />5/1/2014 <br />DAMAGE TO HEN TEDPREMISES Ea occurrence <br />$ 300,000 <br />MED ESP (Any one person) <br />$ 10,000 <br />PERSONAL& ANA INJUR9 <br />$ 1, 000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN AGGREGATE LIMITAPPLIE.S PER. <br />PO L ICYL PRQ- X LOC <br />PRODUCTS-COMPIOPAGG <br />— <br />$ 2,000,000 <br />S <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident —_.— <br />$ 11000,000 <br />A <br />X <br />ANY AUTO <br />ALL OWNED AUTOSSCHEDULFL <br />A'LL OS AUTOS <br />1 <br />4025961505 <br />5/1/2013 <br />5/l/201.4 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY peracciden0 <br />$ <br />X <br />HIRED AUTOSNOR-OWNEDPROPERTY <br />Xr <br />AUTOS <br />DAMAGE <br />Pe accident <br />$_ <br />Uninsured motorist ro al <br />S <br />UMBRELLA LIAB <br />__ <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />$ <br />EXCESS LIAB <br />CLAIMSMADEAGGREGATE <br />DED RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />ANDEMPLOYERTUARILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(MandatoryinNH) <br />f yyes, describe under <br />NIA <br />4025961410 <br />5/1/2013 <br />5/1/2014 <br />X WCSTATU- OTH- <br />TORY LIMIT', ER <br />E.L. EACH ACCIDENT' <br />$ 1, DO 0, 000 <br />- <br />EL. DISEASE -EA EMPLOYEE <br />S 11000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 11 000,000 <br />DESCRI PTI ON OF OPERATIONS below _ <br />I <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />Coverage subject to policy forms, terms and conditions.City of Santa Ana, its officers, agents and <br />employees and representatives is Named as Additional Insured - Designated Person or Organization. <br />Insurance is primary & non-contributory. �R y�ypy�ypr qre, rytS TO �wO <br />.1P],PPJ.1a.AV fro kM FAr7 kL+ ,&'4l ABM. <br />L.,.- —�. <br />PQ c arK / / <br />City of Santa Ana Parks, Recreation and C <br />Services Agency <br />Attn: Silvia Cuevas 26 Civic Center Plaza <br />Santa Ana, CA 92701 <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 />AUTHORIZED REPRESENTATIVE <br />Scola/KRE��-a-�,-- <br />ACORD 25 (2010105) <br />IN902R inn inns/ n, Th. Ar:nRn ro mn nnrl Inns aro rnnlcrr,roA marks of Ar'nRn <br />CK�7:7YK:7e\iNP�\1�7tliTi4 <br />