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<br />~ 2/10/2004 15:24 <br /> <br />(1 "P"y./ <br /> <br />,<,,~ <br /> <br />Burnette Insurance <br /> <br />Pam Flowers-+LAURA SHEEDY <br /> <br />2/2 <br /> <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE CSR PF I OAn(M.MlOCtYVY'i) <br />SYMCO-l 02/10/04 <br />P'I\ODIICIIt THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ON~Y AND CONFERS NO RIGHTS UPON THE CERTIFlCATE <br />Burnette Insurance Aqency lIne. HOLDER, THIS CERTIFICATE DOES NOT AMEND. EXTEND OR <br />3447 Lawrenceville Suwanee Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br />Suwanee GA 30024-2402 <br />Phon..: 170-339-8888 Fax: 770-339-1442 INSURERS AFFORDING COVERAGE NAlCII <br />INIUIIO A-~oo'- '8J4 INSUAeRA Zurich u.s. Insurance <br /> 4~~()~' I tcsUFlERB: Leaion Ins=ance C=anv <br /> ~mo Grm" Inf '+~~3-/1).. IN$lJRIERe . <br /> ""'C Dr 1 INSIJRERO <br /> Atlanta GA 3034 -2831 <br /> INSlJRER.E: <br /> <br />COVERAGES <br /> <br /> THE POlICIES O~ INSUIWIC! LISTED eElOW HAil! BEfN ISSlJEO TO THEINSIJRl!I) _C NJlJVf FOR THE POUCY P!RIOD NlICATEO. NOTWlTHSTANDIoKl' <br /> IX( REQI.JlR!M!NT, TERMOR CONDITION Of' IX( CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IM-ilCli TtIS CERTIfICATE IMY BE ISSUED DR <br /> MAY PERTMl, THE tlSUIWICE N'FORDeD BY THE POLICICS CESCRIBEO _IS SUIlJECT TO ~ THE TERMS, EXCLUSIONS AND CONCITIONS OF SUCH <br /> POLICIES. AGGREGATE LNITS SHOWN MAY HAVE BEEN REDUCED BY PAID a.AIMS. <br />~;; ;;-... ,.."IOPIrlI\llWlCI POUCY MUMlIll =T:~ "g~.~~ u..... <br /> .,!!.NUN. L.NUrY WHOCCURRENCe '1 000.000 <br />A X CCMlERCIAL. GEMERAL UA8lUTY 040972979 07/31/03 01/31/04 PReMlSeiiiEalXClftl'Ic'l '300 000 <br /> 1..-""", ~ OCCUR Ml:o.ElCP(ArI'f-DnlpelSOl'1} '10,000 <br /> PERSOfrI.I\I..&!ttN1NJtJRY . 1 000 000 <br /> f----' GENERAL.,IQI:)Q~TE '2 000 000 <br /> / OEN\..&.C)(R~n~~Sn PROOUCTS. CONfNOPJDG , 2,000,000 <br /> Iil POUCY .EeT LOC <br /> ~OMClHl LJMIUTY C~ilNGL.ELlMIr , 1,000,000 <br />A ~ NNAl.JTO 040972979 01/31/03 07/31/04 (Ea.etdlllf) <br /> f- ALL O'Y'MI!O AlJTOS 800LVlNJURY <br /> . <br /> f-- SCHEDULfOAUTOS (l"lrptrlon) <br /> ~ IlREO!JJros BODl v IHJURV <br /> . <br /> ~ NOH-OWNEO ...ufOS (p<<.ddtrt) <br /> f-- PROPE~TV~ . <br /> (Pel'Kcklat) <br /> R'~ NJlOON..Y-~ACCOE.o.JT , <br /> _'"'0 NO~ Al?PLI CARLE ...."'c , <br /> O'THEFl'TJol,l,N <br /> ,AUTO Oft.. V: "". , <br /> ~lJ/UIIIIIlUlUUUIU1'Y fACii OCCURRENCE '1 000 000 <br />A Ix OCCUR D CI.I.ItoIS IoW)E 040972979 07/31/03 07/31/04 AGG~TE , 1,00D,000 <br /> , <br /> ~ ..~<e< , <br /> Ii" "TEHTlOO '0 , <br /> WOAtWttc~'TIONAND J: lro~ylILMTS I 101::- <br />R IMJlLDYlRI'LMMlTY WC!50!l483!l1 11/28/03 11/28/04 <br />NH~QMlARTNSlJMOUTM! ILEACHACClOEHT . 100,000 <br /> OFFIC~~LUOeO? . '100 000 <br /> I.L. DiS!ASE. E"aP\.O'I!E <br /> ''''1. llntrIJe l.IIIer <br /> sPl!!ClolLIlROVISIOfolSDeIOW e.L 0IS9.SE. PO.J:YLNT . !l00 000 <br /> 0T1WI <br />DIICIWt'nONO'O'....noMIJLOCATtON.I'dHICI.b'.lCCL.U...MlDlD".NI)~'.,ICIALMCMI... {!.pp Et" - P . . <br />Cert.ificate holder is list.ed as additional insured as per contract.ua' ROV~.0 r\" TO fORl\.l <br />obligation./Faxad 714-647-!l406.SEE REVISED wc XRrO~ION. -~./!-f........._.. <br /> LcuJ:ra. S~.r~ SI1v'.~,J" <br /> Assistant Cit\, f. tror-;~'~\' <br /> . . <br /> <br />CERTJACATE HOLDER CANCELLATION <br /> <br />SANTAAN' IHOLlU) ANY O,THI AllOY! DIICIUIIUl If'OUc:llI.. CANCIU.EI IUOU THlIXNtATlOH <br /> <br />DATIi'lMIRlO'. TH' I..UINC INIUltiR WlU iNI)IiAVO~ TO MAIL <br /> <br />30 <br /> <br />OA'I"W..rTT!H <br /> <br />Ci~y of Santa Ana <br />Linda Kelley <br />20 Civ~c Center P~aza <br />Santa Ana CA 92702 <br /> <br />NOTJlilili TO THE CERTIFICATE HOLDER-NAMED TO THi LEFT. BUT FAlLURE TO tl.o!lO lHAI...L <br />IMPose NO OBUDATlON ClItUABlutYOF ANY KIND U.-ONTHI!.INDUR/Jl\.mAOEtlTlI OR <br /> <br /> <br />&nJF <br /> <br />- . ---- ------...-....... ..,.... <br />