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AC"R" <br />DATE (MMIDDlYYYY) <br />CERTIFICATE LIABILITY INSURANCE <br />06/03!2016 <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 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 I CONTACT <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, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />--.. --- — <br />INSR: 'iAODLSUBR' <br />LTR TYPE OF INSURANCE <br />POLICY EFF POLICY EXP <br />POLICY NUMBER MMIDDNYYY MM/DDIYYYY LIMITS <br />COMMERCIAL GENERAL LIABILITY,,', <br />EACH OCCURRENCE $ <br />T ! <br />_� CLAIMS MADE OCCUR <br />DAMAGE TO RENTED ____) <br />PREMISES (Ea occurrenceZ_ .G, ._______ . _------ <br />--- ---- - --...---------- <br />l <br />! MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />I <br />L V <br />_I E LIMIT APPLIES PER <br />GENERAL AGGREGATE $ <br />t...._ <br />„ _� POLICY EOT LOC <br />.. _..._ .... <br />PRODUCTS COMP/OP AGG $ <br />-- --._ --- --..-_...- -._._- <br />1 OTHER:,, <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />Ea accident <br />_______ <br />ANY AUTO <br />BODILY INJURY Per person) $ <br />J ( P ) <br />ALL OWNED SCHEDULED <br />A AUTOS AUTOS X <br />BODILY INJURY (Per accident) <br />ACP BAPD 2555084678 06/01/2016 06/01/2017 $ <br />II <br />NON -OWNED <br />HIRED AUTOS /'� <br />I <br />L 1 AUTOS - <br />PROPERTYDAMAGE - - <br />(Per accident___- <br />I$ <br />UMBRELLA LIAB OCCUR <br />I EACH OCCURRENCE $ <br />- _- <br />EXCESS LIAB CLAIMS -MADE! <br />L—----'— —- <br />I ------------ <br />AGGREGATE <br />---- ..... _.--._— --_.__............._-- <br />DED -, RETENTION $ <br />. 5...._.....-- <br />WORKERS COMPENSATION <br />1 PER OTH- I <br />AND EMPLOYERS' LIABILITY YIN❑, <br />STATUTE ER _ <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />'�, <br />/"� E.L.EL EACH ACCIDENT $ <br />OFFICER/MEMBER EXCLUDED? N IA <br />in NH) <br />-- ---- -- - <br />/,, <br />(Mandatory <br />If yes, describe under <br />_., _ .. _.E L DISEASE EA EMPLOYEE, $ <br />J <br />f <br />DESCRIPTION OF OPERATIONS below <br />G-ZIEV4L.VVL..Ct BY ,�j Q EUNI E I (1...RE 1 (PG �6I ) <br />✓. _ ..._.-_ . _. b..._ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />%,cm l lrlt../i i c nVLLlcm <br />City of Santa Ana <br />20 Civic Center Piz # M-36 <br />Santa Ana <br />CA 92701-4058 <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 />Lyssa Yadvish <br />071988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />