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HODGES LACEY & ASSOCIATES, LLB; A­2014-037 REVIEWED BY: EUNICE HEREDIA (PG 1 OF 24 <br />OP ID: SG <br />DATE JMMIDDfYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 06101/2015 <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 />John J. Matsock & ASSOC. Inc. <br />1750 N Washington Street <br />Naperville, IL 60563 <br />Steven L. Monteith <br />INSURED Hodges Lacey & Ass, <br />19647 Valley View Dr <br />Topanga, CA 90290 <br />COVERAGES <br />LLC <br />NOTRIF]w <br />INSURERA: Hartford Insurance Company 29424 <br />INSURER 8: <br />CERTIFICATE NUMBER: REVISION 'NUMBER: <br />III <br />THIS <br />INDICATED. <br />CERTIFICATE <br />EXCLUSIONS <br />SR <br />L <br />A <br />IS TO CERTIFY THAT THE POLICIES <br />NOTWITHSTANDING ANY REQUIREMENT, <br />MAY BE ISSUED OR MAY PERTAIN, <br />AND CONDITIONS OF SUCH <br />TYPE OF INSURANCE <br />GENERAL LIABILITY <br />_7X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE A J OCCUR <br />L <br />OF INSURANCE <br />POLICIES. <br />x <br />TOUR <br />WVn <br />LIST ED BELOW HAVE BELIN <br />TERM OR CONDITION OF ANY <br />THE INSURANCE AFFORDED BY <br />LIMITS SHOWN MAY HAVE BEEN REDUCED <br />POLICY NUMBER <br />83SBVX6302 <br />1��Utu I U <br />CONTRACT <br />THE POLICIES <br />BY <br />--- POLICY I�F­F <br />(MM1OD=) <br />05120/2015 <br />11,117 HNIOUMCU <br />OR OTHER DOCUMENT <br />DESCRIBED <br />PAID CLAIMS <br />jMMLq9n= <br />05/2012016 <br />WITH RESPECT TO WHICH THIS <br />HEREIN IS SUBJECT TO ALL THE TERMS, <br />LIMITS <br />EACH OCCURRENCE $ 2,000,OOC <br />__DAMA_GPI_9_R_E 9T_EI5___ <br />EEgmlaES IEa occurrence <br />_L 300,00C <br />(Any EXP �jy one Parson)_ <br />$ 10,00( <br />PERSONAL & ADV INJURY <br />$ 2,000,00( <br />GENERAL AGGREGATE <br />$ 4,000,00( <br />PRODUCTS - COMPIOP AGG <br />$ 4,000,00( <br />GENT AGGREGATE LIMIT APPLIES PER <br />X1 POLICY[—"] M F-1 LOC <br />COMBINED SINGLE LIMIT <br />$ <br />AUTOMOBILE LIABILITY <br />(Ea accident) <br />$ <br />BODILY INJURY (Per person).., <br />erson) <br />$ <br />ANY AUTO <br />BODILY INJURY War accident) <br />$ <br />ALL OWNED AUTOS <br />PROPERTY DAMAGE <br />(PER ACCIDENT) <br />$ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS. <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAR <br />CLAIMS MADE'... <br />_AI3GREGATE <br />DEDUCTIBLE <br />RETENTION $ <br />WORKERS COMPENSATION <br />ATU- JOTH- <br />w sT T <br />_AQcM,8� -__L_ER <br />E.L. EACH ACCIDENT <br />S <br />AND EMPLOYERS' LIABILITY YfN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />OFRC5RJMEMBER EXCLUDE ❑ <br />(Mandatory in NH) <br />N/A <br />--DE,,R,PT,6b'1'4 <br />A <br />If yes'dosc' `O`Ve0'PERAT]ONS beIow1 <br />Property Section <br />i <br />83SBVX6302 <br />T51201201 6 <br />E.L. DISEASE - POLICY LIMIT' S <br />Ded $250 1,000 <br />I rk Schedule, if fnore spat® Is required) <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aftach ACORD 101, Additional Rerna S Sch <br />ADDITIONAL INSURED WIT'H RESPECTS TO GENERAL LIABILITY PER WRITTEN <br />CONTRACT, CITY OF SANTA ANNA ITS OFFICERS, EMPLOYEES, AGENTS, <br />VOLUNTEERS AND REPRESENTATIVE6 "THE INSURANCE AFFORDED BY THE <br />POLICIES DESCRIBED HEREIN IS SUBJECT TO THE TERMS AND CONDITIONS <br />­- -r T711TVCII <br />SANTAAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />CITY OF SANTA ANNA ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA, CA 92702 AUTHORIZED REPRESENTATIVE <br />h-e%Danoh-rlrNM Ali Ai htc aQcS rvPri <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />