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<br />TE CERTIFICATE OF LIABILITY INSURANCE DA 051081W
<br />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 />IMPORTANTa 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 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 Phone: 714 -369 -2998 NAME "cT Stephanie Dufour
<br />Dufour Insurance Services, LLC Fax: 714.540 -6357 PHONE 714.369 -2998 PAZ
<br />6619 Littler Drive ac ry tnrc, Not: 714- 840 -6367
<br />Huntington Beach, CA 92649 ��� mIE��. Ste IrmNlal8ldnfourinsurance.com
<br />HfTiE T47
<br />92702
<br />Travelers
<br />Insurance
<br />CfIVFRA[;FS CFRTIFICATF 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. P(DOOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />Prank Hernandez
<br />ILTR TYPE OF INSURANCE ( _ ---- POLICY E
<br />O ICY NUMBER fmV.10 11 M1D
<br />LIMITS
<br />GENERALLIASILITY !
<br />EACH OCCURRENCE $ 1,OD0,00
<br />A X COMMERCIAL GENERAL LIABILITY X 660$802700913 0570212013 0fit0212014E
<br />I
<br />ETV ENIEU
<br />PREMISES Eaaxurrenca� If 100,00
<br />CLAIMS -MADE ® OCCUR
<br />MED EXF {Any ane arson $
<br />PERSONAL 8. AOV INJURY $ 1,000,00
<br />GENERALAGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER,
<br />PRODUCTS - COM PIOP AGG $ ....
<br />—_ PRO-
<br />X POLICY LUC
<br />....................._�___°'___
<br />Dad: $0 $
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,OD0,00
<br />(Ea accident) _
<br />A ANY AUTO X BABB04667613 0610212013 OSID2/2014
<br />I BODILY INJURY (Per Person) I $
<br />ALL OVMED SCHEDULED
<br />AUTOS X AUTOS
<br />t�T�
<br />BODILY INJURY (Per accidenp, $
<br />X TOED
<br />X I AUS
<br />P�cdeoHIREDAUTOS
<br />eraal ll
<br />Dad- $5001$1000 $
<br />X UMBRELLA LIAR LXJ OCCUR
<br />EACHOCCURRENCE $ 4,OOD,OD
<br />C EXCESSLIAB CAMS -MADE X CUP3909T/2013 0610272013 05 02 2014
<br />AGGREGATE g........... 4,600,00
<br />O
<br />^�
<br />$DE ..._
<br />WORKERS COMPENSATION
<br />X WC 57ATU- TH
<br />r AND EMPLOYERS' LUUNLITY YIN
<br />Y LIMR -
<br />B ANY PROPRIETORIPARTNER /EXECUTIVE BB1113617 02/0812013 0210812014
<br />E, L. EACH ACCIDENT $ 1,00%000
<br />OFFICEFUMEMBER CXCLUDEDV F7 NIA
<br />(Mandatory IA NH)
<br />E L DISEASE - EA EMPLOYELI S 1,000,00
<br />If 9es desonbe unbel
<br />DES�R T OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />• Profassional Llabl X 6608802700913 05/0212093 05/0212014
<br />Per Occ 1,000,00
<br />• Abuse Liability X 66OBB02700913 06/0212013 05/02/2014
<br />Aggregate 1,400,0
<br />&,
<br />To
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AMO ACORD 101, A0011onal Remarks Schedule, If more specs Is regUredl
<br />Rea CDBO, HBO, and HIPRF grants, City of Banta Ana, its officers, amplo7ess,
<br />�� V �
<br />agents, voluntears and representatives are named additional insnzads with
<br />respect to the operations of the named insured & this policy is primary per
<br />the attached andorsereent> Workes compensation coverragee excluded,
<br />4�ttY`�' {L)Tnt'I
<br />onl y lfl days notice of cancellation for Ann- p a e
<br />L1SR
<br />CFRTIFICATF HOLDER CANCF_I_I_ATION
<br />(D 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Prank Hernandez
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CIA 92702
<br />(D 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD
<br />
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