|
<br />na';j (:.....,J U..J U'-. .....["'"
<br />
<br />, ...
<br />
<br />ACORD CERTIFICATE OF LIABILITY INSURANCE I OATElliIMIbOf'f'Y'fY)
<br />~._--_.~~..... OS/23/2005
<br />PRQOue... (714) 941-5830 THIS CEIlT1FICAlE IS ISSUED AS A MATTER OF INFORMATION
<br />DanieJ. BuckJ.ey Insurance Services ONLY AND CONFERS NO RIGHTS UPON THIF. C,ERTIFtCA TE
<br />HOLDER. lHlS .~~P'~ICA 1E DOES NOT AMEND. EXTEND OR
<br />16651 Gothard St Ste A-l ALTER .rnE COy AfFORDS> BY THE POLICIES BELOW.
<br /> ,
<br />~ington Beseh c>. 92647- INSURERS AFfORDING COVERAGE NAle..
<br />lNSUftEll INSURERA:Uartford Caaualtv Ins Co
<br />DM&M Capi t,,"1 Inc. Dba Nationa1 Visual. SysteDts lN$lJRERB.- Pref"errad Emnlovtill1:'s
<br />5482 Oceanus Drive fG N- aOcH -/3 '! INSUREItC
<br /> WSURERO
<br />Huntinaton Beach CA 92649- INSI.IRERE:
<br />
<br />COVERAGES
<br />
<br />THe POlICIES OF INSURANCE LISTED BELOW HAVE Bl!eH ISStJEO TO THE lNSUR!:;D NAMED ABOVE FOR TI-tE POLICY PERIOD INDICATED. NO~THSTANDING ANY
<br />REQUIREIIIENT, TERM OR CO~tTION OF ANY CONlRACT OR oTHER: DOCUMENT WTH RESPECT TO WHICH nus CERTIFICATE MAY BE ISSUED OR MAV PERTAIN,
<br />me lNSuAANCE AFFORDED BY ""E POI.IClES DESCRIBED HERE.. IS SUbJECT TO ALl THE TERMS. EXCLUSIONS AND CONDITJONS or SUCH PQLK:IES.
<br />AGGRFGA TE uurrs SHOWN MAY HAVE BEEN REDUCED BY PAlO ClAIMS.
<br />"50 OO'L TYfoE. Of" INSURANCE POUCY MUM\N!.1t ~ALfi:~g~8~,E ~::I=m-:.;~
<br />lTR NSRD LIMITS
<br />A ~"ERA.LI.1A..un 1 1 1 / eACH OCClIRR[!.lCE . 1,000,000
<br /> ~p~EtIClAL GENEORALl.IA81LlTY ~~~JOS:~~ltnc.) . 300 ~~
<br /> _ CLANS "'DE 0 OCCUR 39SMlUS:nS 0'/01/2005 05/0'/200' Ml!De<"(A. _,1111'$0/'\) , 10,OeC
<br /> ~ ~~& AD\! IN,)LJRY . 1,000 I OQO
<br /> - / / 1 1 GEJlERALAGGREGl.Tf . 2,000.ODO
<br /> -ii-l ^GG:En~ l.IMIT ^A:PEft I'ROQUCT5. CDMP!OP AGG ~ 2,000,000
<br /> X POLICY r;~g- LOC 1 / 1 /
<br /> ~UT<*O"'U'. U4BtllTY 1 / / / COMBINED SIHGlE LIMIT lrOOO,OOO
<br /> {EaaCCi4&n11 .
<br /> - AmAvro
<br />A - ALL OWNED AUTOS 39SBAJU8315 05/01/2005 0'/01/200' 600ft....,N~Y
<br /> (P'El'pWSooIl) ,
<br /> - SCH~OULEbAtJTOS
<br /> ~ }-IJI?I00AVTOS 1 1 / / f!OOlLY INJURY
<br /> IPor~nl} ,
<br /> ..! NON-OI/I,INED AI.JTOS
<br /> / / / / MOPERlY OMMGj;;
<br /> (PerllWclelll) .
<br /> R.w....'" "UTI) OM.. v _ Ell. A.CCIm;:A;T .
<br /> AN" AUjO / 1 / I O'-HER THAN EAACC S
<br /> II.U1"C) O~l y AGG ,
<br />A ~:.tSIUM8RE1.LA L1A8IUTv 3938NU0315 05/01/2005 05101/200. f ~4{'.liOCCUIU'E"NCf': , 1,OOO,~
<br /> OX OCCUR 0 ClAIMSIMOE ^GGIl:EG....re , 2.. 000,000
<br /> ,
<br /> ~ ~DVCT>>tLt / / 1 I .
<br /> X RETENTION .$]0,000 ~mr~",1 IO,;r" ,
<br />B WORKERS COMPEHSAf1DN ANI) WKN123091-.l 06/24/2004 06/24/2005
<br /> EMPLOYERS' UASollITY 1,000,000
<br /> II.NV PROPRIETORIP"'AlNE~te.xI':CllTllfE: c.L EACH ACCIDUH_ .
<br /> OffICER/Ml::.\4B(R ~Cl.UD&D? 1 1 I I E.l. DISEASE - fA EMPLOYEE$' 1,000,000
<br /> lfylltll.dUcliblllf'ldltr 1,000,000
<br /> SPECIAL PROV1SfON!i Ct!lkl'W E.L_ DolSEASt:. POLICY LIMiT S;
<br /> OTIUIl 1 1 / 1
<br /> 1 I 1 1
<br /> I I I I
<br />OE;SCltfPTtON OF OPERA flO.lI8I1.OCAlIDMSNEHlCl'Eall!X<::lU$lO~ ADOI!D BY EN I)OASEMEH'OSPECI,"- PJlO\IJSlOlll$
<br />~ Cit.y of SOionU Ana, 20 Civic:: C-antc.r Pl.aza. SMta AtJ,~, ClIo.U..fu.:m.i.iIo 92701, i.t.'B ut~ioorfl, employees, &glints and
<br />rop:J:esent&UWlos llIrQ namGd Illlll a.dditional :l.na\2Nd. .ith. ~ t:o GfUMlra1 r..:t.abi.H.ty a!l; t:hilftr i.n.t:8r..~ lIl.l'I.y &pPQfl.J:'.
<br />
<br />CERTIFICATE HOlDER
<br />(714) 565-2690
<br />
<br />(714) 565-2693
<br />
<br />CANCELU-nON
<br />attOUlD- AWf Of THE AQOYE DESCRIBED POLlCln Be CAH(;EUED _'-ORfi TIfE
<br />EXPmAl10N DAll! "THEREOF, THE ISSUING INSURER WlI..I. TO MAIl.
<br />30 DAYS wrunEN Ncmc:E 10 ntE CERl1FICAU; tWLDliR NAlfeo TO THa LEn,.....
<br />
<br />The Depot of Santa Ana r II r IlTI If II
<br />100 &ast. Santa Ana B1vd.
<br />Sui tQ 108 E PMf!:EIITAnw
<br />Santa Ana CA 92701 :--- ~
<br />ACORD l5 C2001/1l81
<br />ft.....INS025 rotll8l,as Eler.l1l:QNlC LASEH FORMS. !NO . (AD0)327.u~&
<br />
<br />T j
<br />
<br />-- 't - -
<br />
<br />-- --
<br />
<br />~ACORDCORPORATlOH'~8
<br />Psg81of2
<br />
<br />APPROVED AS TO FORM
<br />
<br />), \( ( ,; {c I //~..::?
<br />Laura \Kfrt,Shccuy
<br />^:;:;istantt.~ilY Attorney
<br />
<br />~.d
<br />
<br />1:1.. 111
<br />
<br />dIS:20 SO S~' ~"W '
<br />
|