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<br />-r <br /> <br />ACORD. CERTIFICA TE OF LIABILITY INSURANCE OP 10 J~ DATE (MMIODIYYYY) <br />ADVAN-6 11/11/04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Bolton , Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />CA License #0008309 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />245 S. Los Robles Ave, Ste 105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Pasadena CA 91101 <br />Phone: 626-799-7000 Fax:626-441-3233 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Westport Insurance Corporation <br /> INSURER 8: Fireman's Fund Insurance 21873 <br /> Advanced Automated Systems Inc INSURER c: Peerless Insurance Comoany <br /> 23691 Via Del Rio INSURER 0: State Compensation Ins. Fund 35076 <br /> Yorba Linda CA 92887 <br /> INSURER E; <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE fMMfDDIYYI- DATE MMfDD1YYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> f.- <br />A X X COMMERCIAL GENERAL LIABILITY RPI017641 01/18/04 01/18/05 PREMISES YE~~~~~nce\ $100,000 <br /> I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $10,000 <br /> ~ $1,000 PD Ded PERSONAl & ADV INJURY $1,000,000 <br /> '- GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APf!YIPER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> 'I ( Iil PRO- <br /> POLICY JECT LOC <br /> ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br />C 1C. ANY AUTO BA9891367 11/13/04 11/13/05 (Eaaccidenl) <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS {Per person) <br /> - <br /> - HIRED AUTOS BODILY INJURY <br /> $ <br /> NON..QWNED AUTOS (Peraccidenl) <br /> I-- <br /> r- PROPERTY DAMAGE $ <br /> (Peraccidenl) <br /> GARAGE LIABILITY ~ l.t'..e{7 AUTO ONLY - EA ACCIDENT $ <br /> R ANY AUTO OTHER THAN EA ACe $ <br /> AUTO ONLY: AGO $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 <br />B ~ OCCUR 0 CLAIMS MADE XSMOO076293380 01/18/04 01/18/05 AGGREGATE $2,000,000 <br /> $ <br /> ;=1 DEDUCTIBLE $ <br /> X RETENTION $0 $ <br /> WORKERS COMPENSATION AND X JIORY Ll~WS I !UER- <br />D eMPLOYERS' LIABILITY 713886405 11/13/04 11/13/05 $1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1 000,000 <br /> ~P~~I~tS~~V~~?~~S below E.L. DISEASE - POLICY LIMIT $1,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />The city of santa Ana and Siemens Building Technologies, Inc. , their <br />officers,employees,agents,volunteers and representatives are included as A/I <br />per form CG 2009 (7/96) attached. Primary wording per the attached. <br />Job: City of Santa Ana HVAC Building service agreement. <br />*10 Notice for non payment @ <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />City of Santa Ana <br />Attn:Clerk of the City Council <br />20 Civic Center Plaza (M-30) <br />P.O Box 1988 <br />Santa Ana CA 92702 <br /> <br />SANTAAl <br />~. <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WIL' . MAIL 30. DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF I <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br />@ACORD CORPORATION 198 <br />