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ACORD CERTIFICATE OF LIABILITY INSURANCE o9i18/~zoo~3' <br />PRODUCER (949) 709-8800 FAX (949) 709-1668 <br />Comprehensive Insurance Services <br /> <br />22342 Avenida Empresa THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Suite 200 <br />RSM, CA 92688 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />MSURED INSURER A: MARKEL INSURANCE COMPANY _ <br />CAMP FIRE USA ORANGE COUNTY COUNCIL INSURER B: <br />14742 PLAZA DRIVE, STE 205 INSURER C: <br />TUSTIN, CA 92780 <br />I INSURER D: <br />/y/~ <br />~~ ~D / / ~~ INSURER E: <br />T:nVFRAf:FS <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 7HE POLICY PERIOD INDICATED. NOTWITHSTANDINL <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAY PERTAIN, 7HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMBS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TTPE OF WSWtANCE POLICY NUYBER POLICY EFFECTNE POLICY F]~mATION L11ARS <br /> GENERALLWBILm 8502CY243262 06/20/2003 07/12/2004 EACH OCCURRENCE s 1,000, <br /> X COMMERCIAL GENERALLIABSfiY DAMAGE TO RENTED E lOO, <br /> CIAIMS MADE Q OCCUR MED EXP (My ane pmm~) $ 5 , <br />A PERSONALSADV IWURY S 1,000, <br /> GENERAL AGGREGATE E 3 , 000 ~ <br /> GENY. AGGREGATE UMR APPLIES PER PRODUCTS-COMP/OP AGG f 1,000, <br /> POLICY JECT LOC <br /> AU TOIAOmlE LV181L1TY 1002CY243263-1 06/20/2003 07/12/2004 coMBINED SINGLE LIMIT <br /> X ANY AI7T0 (Ee ealOerM1) S 1 s D00, <br /> ALL OWNED AVTOS BODILY IWURY <br /> <br />A SCHEDULED AUTOS (Per Person) S <br /> <br /> HIRED AUTOS <br />BODILYIWURY <br />S <br /> NONOWNED AUTOS (Per actltlent) <br /> PROPERTY DAMAGE <br /> <br />(Per ecdtlenp - f <br /> GARAGE LIABILRY AUTO ONLY-EA ACpDEM S <br /> ANY AUTO OTHER niAN EA ACC f <br /> AUTOONLY: AGG S <br /> EXCE89AIMBRELLA WBILRY EACH OCCURRENCE S <br /> OCCUR ~CWMS MADE AGGREGATE S <br /> S <br /> DEDUCnBLE s <br /> RETENHON S S <br /> WORMJtS COMPENSATION AND WC STATU- OTf4 <br /> EMPLOYERS' LNBILRY <br /> ANY PROPRIETORrt+ARTNER/EXECUTNE <br />E.L FAGHACGDENT <br />S <br /> OFFICER/MEMBER E%CLUDEDT E.L DISEASE-EA EMPIOVE E <br /> M yse, tlesulW vMar <br /> SPELW. PROVIS%NlS EWav E.L. DISEASE-POLICY LWR S <br /> OTHER <br />ITY ~ ~ A ANA$/ IT1S~~FFw11cIE~t5,~1~E1 ,~PLOY~~SLI~IN~EERSARE NAMED ADDITIONAL INSURED <br />ER THE ATTACHED FORM IL 12 O1 11 85. <br />10 DAY CANCELLATION NOTICE FOR NON PAYMENT OF PREMIUM <br />SNWID ANY OF THE ABOVE DESCRIBED POLIGIEB BE CANCELLED BEFORE THE <br />E%PIRATgN DATE THEREOF, THE ISSUWG MSURER WILL ~Xl~l{ MAIL <br />CITY OF SANTA ANA - CDBG M-25 *30 DAYS VmmEN NOTICE TO THE CERTIFICATE HDLDEit NAMED TO THE LEFT <br />COMMUNITY DEVELOPMENT AGENCY X' <br />PO BOX 1988 M-25 YdU4WXd{ID(11R4J( XXXXXX7C <br />SANTA ANA, CA 9C/VL ~'RO VED AS TO FORM AUTeww>Z:D REFREBERTATrvE <br />/X1L Richard EVnon. CIC/]EREMY 4Z~,.._ <br />ACORD 25 (2001108) 0 ~ ~ y~ CORD CORPORATION i988 <br />Deputy City Attorney <br /> <br />