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`aka 'l`� CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM)DD/YYYY) <br />11/20/2018 <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 SUBROGATIONIS WAIVED, subject to the <br />terns 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 endorsemengs). <br />PRODUCER <br />CONTACT <br />PAYCHEX INSURANCE AGENCY INC/PAC <br />76250881 <br />NAME, <br />PHONE (877)287-1312 <br />INC, No, Eat): <br />FAX (888)443-6112 <br />(AIC, No): <br />150 SAWGRASS DRIVE <br />E-MAIL <br />ROCHESTER NY14620 <br />ADDRESS: <br />INSURER(s) AFFORDING COVERAGE NNCe <br />INSURER A: Hartford Fire and Its P&C Affiliates 00914 <br />INSURED <br />INSURER 8: <br />ORGANIZATIONAL QUALITY ASSOCIATES INC. <br />INsuRERc: <br />2802 MOORINGS WAY SE <br />INSURER D: <br />SOUTHPORT NC 28461-8328 <br />INSURER E : <br />INSURER F: <br />COVERAGES 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 />INDICATEDMOTWITHSTANDING 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 <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSS <br />TYPE OF INSURANCE <br />ADDL <br />SUB <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />OMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLNMS-MADE ❑OCCUR <br />EACH OCCURRENCE <br />DAMAGE TO RENTED <br />MED EXP (Any one P.mor) <br />PERSONAL B ADV INJURY <br />GEWL AGGREGATE LIMIT APPLIES PER <br />PoLICY ❑ P"o- ❑LOC <br />OTHER: <br />GENERAL AGGREGATE <br />PRODUCTS-COMPIOPAGG <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED F7SCHEDUUED <br />AUTOS AUTOS <br />HIREDAUTOS NON-0WNEO <br />AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea mxidene <br />BODILY INJURY (Per P.) <br />BODILY INJURY (Per accident) <br />OPERTY DAMAGE <br />r acddenl <br />UMBRELLA LIAR <br />EXCESS UAB <br />OCCUR <br />CLAIMS -MAGE <br />CHOCCURRENCE <br />!AGGREGATE <br />OEO RETENTION S <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNERIEXECUTIVE yN <br />OFFICERIMEMBEREXCLUDED? <br />(Mandatory In NH) <br />Ifyes, describe under <br />DESCRIPTION OF OPERATIONSI <br />NIA <br />76 WEG GH8529 <br />03/19/2018 <br />03/19/2019 <br />PER OTH- <br />STATUTE <br />E.LEACH ACCIDENT $1,000,00 <br />c <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />E.L. DISEASE -PoLICY UMR $1,000,00 <br />DESCRIPTION OF OPERATIONS/LOCATIONS / VEHICLES (ACORO 101, AddRional Remarks Schedule, may be anacbed It more space is mqulrW) <br />Those usual to the Insured's Operations. <br />CFRTIFICATF HOLDER CANCELLATION <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 CIVIC CENTER PLZ <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />SANTA ANA CA 92701 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />=w/rAwndiffel ri—wra <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />