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1 ® <br />A� l7 CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDNYYY) <br />07i24r2014 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy)les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Yutz Markle Insurance Agency, Inc. <br />205 Lifeline Road <br />Suite 101 <br />NprNTF�' Sharon McW In <br />PwoxE FAX <br />a :p;j57.0 421 -7300 ac Na :570 421 -0785 <br />aooARL :email utzmerkle.com <br />Stroudsburg, PA 18360 <br />INSURERS AFFORDING COVERAGE NAIC a <br />INSURER A: <br />INSURED <br />INSURERB:Erie Insurance Exchange <br />$ <br />Ernest C Swiger <br />123 Acorn Lane <br />INSURER C <br />Stroudsburg, PA 18360 -8324 <br />INSURER 0: <br />DAMAGE TO R <br />PREMISES Ea ocw,rence <br />$ <br />INSURER E: <br />$ <br />INSURER F: <br />C! PRAGER 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 8E 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 />MSR <br />TYPE OF INSURANCE <br />AD.T.U- <br />POUCYNUMBER <br />POLICY D /YYYY <br />POLICY D EXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE ❑ OCCUR <br />DAMAGE TO R <br />PREMISES Ea ocw,rence <br />$ <br />MEDEXP(Anycmeperaon ) <br />$ <br />PERSONAL &ADV INJURY <br />$ <br />GENT AGGREGATE LIMITAPPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMP /OP AGO <br />$ <br />POLICY ❑JET F LOC <br />$ <br />OTHER: <br />B <br />AUTOMOBILE LIABILITY <br />COa MaBBINED SINGLE T <br />$ <br />BODILY INJURY (Per person) <br />$ 500000 <br />ANY AUTO <br />BODILY INJURY (Par a.Id n) <br />$ 100000 <br />ALL OMED X AUTOS DULED <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTYDAMAGE <br />Pera¢Ment <br />$ 100000 <br />UMBRELLA LIAR <br />H <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB <br />CLAIMS -MADE <br />DED <br />RETENTION$ <br />I $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />STATUTE E H <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />N /A <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS belay <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional RamaN Schedule, maybe aBached if more space Is nyulred) <br />ApppOVED AS TO FOAM <br />LISA . STORCK r <br />Assistant City Attorney <br />City of Santa Ana <br />Community Development Agency <br />20 Civic Center Plaza 6th Floor <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />REPRESENTATIVE <br />M <br />All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />