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A� o CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDIYYVY) <br />10/10I2017 <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 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 />Nr <br />FAX <br />Automatic Data Processing Insurance Agency, Inc. <br />Lle o, Exit <br />NoI:. <br />1 ADD Boulevard <br />aDoaeSS, <br />Roseland, NJ 07068 <br />INSURER(5) AFFORDING COVERAGE NAICN <br />INSURERA: <br />West American Insurance Company 44393 <br />_... _ _... <br />INSURED <br />INSURER B <br />KOCE TV FOUNDATION <br />3080 BRISTOL ST STE 400 <br />INSURER <br />- <br />Costa Mesa, CA 92626 <br />INSURER D <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 759360 <br />REVISION NIIMRFR- <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, 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 <br />REDUCED BY PAID CLAIMS. <br />INSR- ADDLSUBR <br />LIFE TYPE OF INSURANCE INSD WVD POLICY NUMBER <br />POLICY EFP POLICY EX <br />MMIDDIYYVV MMIDDIYYYV LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTED - <br />CLAIMS -MADE OCCUR <br />C_ <br />PREMISES (Ea occurrence) S <br />MED EXP (Any one person) S <br />-5 <br />PERSONAL B ADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE S <br />POLICY PRO <br />.._ JECT LOC <br />PRODUCTS-COMPIOPAGES <br />___..S _. <br />OTHER. <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT S <br />_ <br />(Ea accident)_ <br />ANY AUTO <br />BODILY INJURY (Per person) S <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per acatlend $ <br />NON -OWNED <br />PROPERTY DAMAGE -..5 <br />HIRED AUTOS AUTOS <br />Per accident).. <br />3 <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE E <br />DED RETENTIONS <br />$ <br />WORKERS COMPENSATION <br />X PER OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER _. <br />A ANY PROPRIETOR/PARTNER/EXECUTNE <br />NIP N XWW57936605 <br />E L EACH ACCIDENT S 1,000,000 <br />06/01/2017 06/01/2018 <br />OFFICER/MEMBER EXCLUDED' <br />(Mandatory in NH) <br />E. L. DISEASE - EA EMPLOYEE S 1,000,000 <br />Ifyes describe under <br />1,000,000DESCRIPTION <br />OF OPERATIONS below <br />EL DISEASEPOLICYLIMIT S <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached if more space is required) <br />G�e�a , <br />- <br />VGLLNIIV IY \��\,, ) <br />SHOULD ANY OF THE ABOVE DE�RIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana Public Library <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />26 Civic Center Plaza <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />�_u )it—)It-- <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />