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:roc: t:x g CERTIFICATE OF LIABILITY INSURANCE <br />Da <br />04ri1/2019 <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 <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, sub Bat to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rl hts to the certificate holder In lieu of such endorsement s - <br />PRODUCER <br />CONTACT <br />NA E <br />PHONE FAX <br />AIC Na E: 24D2 12 <br />Automobile Club Of Southern Calliomla <br />2601 S. Rguede Blvd A H302 <br />Las Angeles, CA <br />EfdAIL <br />ADDRESS! <br />INSUREN(S) AFFORDING COVERAGE <br />NAIL # <br />INSURER A : Inllnlly Select Insurance Company <br />20250 <br />INSURED <br />INSURED B : <br />INSURED C <br />Sherman, Brace <br />17120 Ermanila Ave <br />INSURED D <br />INSURED E <br />Tcrmnca, CA @0504 <br />INSURED F <br />COVERAGES CERTIFICATE NUMBER: REVISION MUMRPP- <br />THIS IS TOCERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FORTHE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TYPE OF INSURANCE <br />ADDL <br />INSC <br />9UBR <br />VIVID <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE ❑OCCUR <br />DAMAGETO RENTED <br />PREMISES <br />$ <br />MED EXP(Any one parson) <br />$ <br />PERSONAL &ADV INJURY <br />$ <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERALAGGREGATE <br />$ <br />POLICY ❑ PRO- ❑ LOC <br />CT <br />PRODUCTS COMPOPAGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBNED SINGLE LIMIT <br />(Ea accident) <br />$1,000,000 <br />ANYAUTO <br />BODILY INJURY (Per person) <br />$ <br />A <br />OWNED f SCHEDULED <br />AUTOS ONLY AUTOS <br />X <br />5D4610033573001 <br />D410112D19 <br />D410112020 <br />(Par <br />BODILY INJURY Pe <br />$ <br />PROPERTY DAMAGE <br />(Per accidan) <br />$ <br />HIRED NON OWNED <br />AUTOS ONLY AUTOS ONLY <br />UA%FELLAUAS <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESSLIAB <br />()III <br />DED <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER <br />STATUTE <br />OTH- <br />ER <br />ANYPROPRIETORNARTNEPIEXECUTIVE <br />OFFICEWMEM3ER EXGLUOFp? <br />(Mandatory in NH) <br />NIA <br />ET, EACH ACCIDENT <br />$ <br />ELDISEASE EAEMPLOYEE <br />$ <br />IESSRIPTIONeU,rIbb <br />El-DISEASE-POLICYLI IT <br />Is <br />OFFunder <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACOnD 1IS, Additional Remarks Schedule, may be atmched It more space is req�uIrred! <br />•qy-' <br />CERTIFICATE HOLDER CANCELLATION ' " <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />Santa Ana Public Library <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />26 Civic Center Plaza <br />Santa Ana,CA 92701 <br />AUTHORIZED REPRESENTATIVES <br />301988-2015 ACORD CORPORATION- All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />