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�y✓-" �� _ b' AYE(MM Y) 4ERTIFICATE OF LIABLir INSURSNCE 05t18f201a <br />THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND COWERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND CR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT CT BETWEEN THE ISSUING INSURER{$), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(fes) ir at he endorsed. if SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsements). <br />PRRDUDER 34065 PACIFIC CCOAST HIGHWAY, #2{14 NAa PHONE ETE 4B�OWERSOX TED <br />Pi1C1NE <br />' 01. 3209....__. _..SAC No3: 949- ,8,61 -�#1S9 .- <br />StateFdrrH DANA POINT, CA 92629 - mAIL"" <br />ADDRESS{ r <br />�b __�__,,,- ,,,_INSURER�AFFORDM4 COVEFEAGE _.. _. NAIC# <br />et a_rVpmune nisulance L;Dm all 25178 <br />a NSUREO RICHARD & CHERYL COOK iNSOaERe <br />614 HIBISCUrS I. WAY INSURER C: <br />PLACENTIA, CA 92870 wsuaERb: <br />INSURER r:: <br />NSURERP: <br />CDVFRAr',FR rcaTiclrvnr�. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CON <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE I <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUC <br />TYPE OF INSURAryCE POIJCYNUMBEFI Pdll <br />)ED TO <br />TRACT <br />OUCIES <br />-D BY <br />wYYyI <br />THE INSURED <br />OR OTHER <br />DESCRIBED <br />PAID CLAIMS. <br />000111YY <br />NAMED ABOVE FOR <br />DOCUMENT WITH RESPECT <br />HEREIN IS SUBJECT <br />LIMITS <br />THE POLICY PERIOD <br />TO WHICH THIS <br />TO ALL THE TERMS, <br />REN <br />COMMERCIAL <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE � <br />] <br />❑ <br />EACH OCCURRENCE <br />$ <br />AIv1AGETLTRENTEb' —'� <br />LPgEMI ES {.a�W.�enrR. ., <br />—' ' - - "'— <br />$ .. •.._— ,..— <br />..-_ t __ 9GGUR <br />ono person) <br />S <br />! <br />N(AnY <br />PERS A• <br />LA ADV INJURY <br />$ <br />A <br />J <br />GEN <br />AUTOMOBILE <br />'L AGGREGATE LIMIT APPLIES PER' <br />POLICY PRO LOG <br />LIABILITY <br />Y <br />GENERAL AGGREGATE <br />Pf'OOUCTS- COMPlOP AGG <br />$ <br />$ <br />BINED INGLE LIMT <br />Ea aaidemi_ - „—, <br />— " -- <br />$ 1000000 <br />IN.JURY(Per poison) <br />$ <br />1 X <br />ANY AUTO <br />AUTOS AUTOS <br />ALL OWNED II SCHEDULED 0`NNEO <br />HIREDAUTOS ! 'AUTOS <br />AUTO <br />Q$24922- Ft6.75 <br />1211 <br />015 <br />1211612016 <br />�ODILY <br />!2OILY INJURY(P.m.iderc) <br />$ <br />PRO ERTY t]AMAGEj' <br />Paj �lCCidMk <br />E <br />_ <br />EACH OCCURRENCE <br />,,. <br />$ <br />I <br />UMBRELLA LlAa OCCUR <br />E%CESS LIAa CLAIMS -MADE <br />j/�p <br />I f <br />l✓ A <br />{ <br />! <br />(� <br />\ <br />NIA <br />Y <br />_ <br />AGGRE, ,.... —.... <br />I_VJCSTATU- OTF{- <br />_. �rnY,61M1T,$. <br />E_L. EACM ACCIDENT <br />—.. —. <br />E. L. DISEASE - EA EMPLOYE <br />EL. DISEASE - POLICY LtMITf$ <br />DEO T, ENTIOI,S <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIAWLIlY YIN <br />ANY PROPRIETOR(PARTNER/EXECUTIVE <br />OPPICEIMEMBEgEXCLUDEM <br />(Mandatory iq NH} <br />KYes, deRelleunder <br />S <br />_..— ..... —. —_.. <br />$ <br />- -- - --- — <br />$ �- <br />—... .._ —.. <br />s <br />—^ <br />DESCRIPTION OF OPERATIONS / LOCATIONS [VEHICLES (ARaol, ACORD 101, AddIlAOnpl ROmeds S- Imd -Io, If more 1 <br />pace is mquima) <br />ADDITIONAL INSURED: CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, M -29, P.O. BOX <br />988, SANTA ANA CA 92705 <br />CFRTICICATP Will nco _ _._. <br />---- <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA, M -29 <br />P.O. BOX 1988 <br />SANTA ANA, CA 92702 <br />AUTHORIZED <br />OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />NON DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />WITH THE POLICY PROVISIONS, <br />ACORD 25 (2090/05) The ACORD name and 1090 are registered arks of ACORD 1001486 132849.8 01 -23 -2013 <br />