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CERTIFICATE OF LIABILITY INSURANCE <br />DATM(MMIDOMYYI <br />09/08/2017 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TWE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANOS SOUS NOT CONSTITUTE'A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE. CERTIFICATE HOLDER, <br />IMPORTANT: If the certiffoato holder is an A001'I"IONAL INSURED, tho l l !,!1 (fas) must ba 1 lix tied, If $U9ROGATION IS WANED, subject to <br />the terns and conditions of the policy, Certain Policies may require an endoraaw ant, A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such ends, Oman t a , <br />PRODUCER <br />STEVE DWIGHT <br />StataMrn7 4625 E ANAHEIM ST <br />LONG BEACH, CA 80804 <br />. <br />uiauREo INTERVAI, HCYUSE <br />PO BOX 3366 <br />SEAL BEACH, CA 00740 <br />pN T <br />NAME: PO BOX <br />NONE .682-4fl4.4494 ��-' i���.gA7.6680 <br />AVAIL , patt ,drie3son.Isbe�mstatofarm.Dam <br />..........AFFpRDINa CDV@Rabe m. <br />NAIC4 <br />II A,SWO Form.Muluel Automobile Insura.noo Company <br />IRs e a, <br />25178 <br />I I ER c, <br />INSURER D, <br />INaORti; <br />WRENPMED <br />rnVanamme <br />............ _.. rtG V IOI V M INUARRIINr(; <br />THIS 16 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE, BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFIOATG MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OrSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />E ININSURANCe APPI 1 O CYCFF POLIPOLICYNUMSER D M e0 LIMn3AL <br />GENERAL LIABILITYEACH <br />-MADE OCCUR <br />YPOICY <br />OCCURRENCE <br />WRENPMED <br />EXP A one arsonPEIRSONAL <br />a ADV INJURY'fE <br />08(0712917 <br />08/07/2010 <br />AUTOMOBILE <br />X <br />v <br />�^ <br />LIMIT APPLIES PER: <br />LOS <br />GENELAOOREGATEjET <br />PRODUCTS-OOMPj0PAGO <br />g <br />'oM l danl3l LE LI I <br />g <br />g .. 1,000,000 <br />A <br />LIABILITY <br />ANYAUTO <br />ALL OWNEDk- <br />AUTOSDULES <br />S <br />HIREOAUTO6 OWNIiO <br />S <br />076.7305-C07.75D <br />003-9965-F29.751 <br />082430$-C2'1.751 <br />NOSILY INJDay (Par person) <br />$ <br />BODILY INJURY(Poradoldwt) <br />$ <br />PROPERANX <br />Paracell <br />UMBRELLA LIAR <br />LIARLAIMS•MADE <br />CCUREACH <br />OCCURRENCE_E%DESS <br />AGGREGATE <br />$ <br />. <br />DID RETENTIONS <br />WORXER6 COMPENSATION <br />AND EMPLOYI8RW LIAaILITY YIN <br />ANY PROPRETORIPARTNCRIEXeCUTIVE <br />OFFICERIMEMBER EXCLURF.U9 C_ <br />Ijy In NI.) <br />It OR,deals undof <br />2 S ftIPTJON OP CPERATICN9 ba ow <br />WA <br />E li• <br />T <br />"'""""'^-'-" <br />' <br />ELL EACH ACCIDENT__ <br />$ <br />E.L. DISEASEEA EMPLOYE-'$ <br />E.L. DISEASE ^ POLICY LIMIT <br />8 <br />I <br />DESCRIPTION BP OPERATIONS I LOCATIONS I VEHICLES (ACORD III, Additional Ronlarkx Schodura, may bq ottootiad It Mom xPam is requiretl) <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEER$ ARE NAME ADDITIONAL INSUREDWITH RESPECTTO THE <br />GENERAL LIABILITY POLICY OF THE NAMED INSURED. SUCH INSURANCE IS PRIMARYAND NON-CONTRIBUTORY. <br />CITY OF SANTA ANA COMMUNITY DEVELOPMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />AGENCY (M•25) ADMINSTRATIVE SERVICES DIVISION THE, EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERER IN <br />ATTN: TERRI EGGERS ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA, M-25 <br />SANTA ANA, GA 02701 ADTnpazED EPR'EmATIvi� <br />1 ria AL,vL<u name and Ingo are registered marks of ACORD 1001450 132849.9 O2 -D4.2014 <br />