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<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE CSR PF T DATE (MMIDOIYYYY) <br />SYMCO 1 07/15/05 <br />P~,?OUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Burnette Insurance Agency/Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3447 Lawrenceville Suwanee Rd. ALTER THE COVERAGE AFIURDED BY THE POLCIES BELOW. <br />Suwanee GA 30024-2402 I <br />Phone: 770-339-8888 Fax: 770-339-1442 INSURERS AFFORDING COVERAGE -I:IC# <br /> -- <br />INSURED A-.;;zoo5- ofj7 INSURER A: Zurich U.S. Insurance <br /> I INSURER Bo Legion Insurance Company , <br /> S~co Group Inc. I -- <br /> INSURER c: <br /> 1 5 Satell~te Blvd. Sui te 5 INSURER 0: <br /> Suwanee GA 30024 <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 /> <br />LTR INSRD TYPE OF INSURANCE <br />~l LIABILITY <br />A . X COMMERCIAL GENERAL LIABILITY <br />,-- CLAIMS MADE ~ OCCUR <br /> <br />~ <br /> <br />; GEN'L AGGREGATE lIM!T APPLIES PER: <br />rx-j POLICY n ~r8T ~I LOC <br />~OMOBILE LIABILITY <br />I~ ANY AUTO <br />~ <br />~ ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />X HIRED AUTOS <br />H NON-OWNED AUTOS <br /> <br /> <br />GARAGE LIABILITY <br />R ANY AUTO <br /> <br />, <br /> <br />POLICY NUMBER <br /> <br />PD~';!~}J~flt~\E p(j'kfirl~~hRDA~~N <br />I I <br />07/31/05 07/31/06 <br /> <br />LIMITS <br />EACH OCCURRENCE 1 $ 1,000,000 <br />PREMISES (Ea occurence) .1 $ 300,000 <br />I MED EXP (Any one person) i $10,000 <br />I PERSONAL &ADV INJURY 1 $ 1,000,000 <br />I GENEMlAGGREGATE I. 2,000,000 <br />, PRODUCTS - COMP/O~AGG ; $ 2,000,000 <br /> <br />040972979 <br /> <br />A <br /> <br />EXCESS/UMBRELLA LIABILITY <br />~ OCCUR !..=J CLAIMS MADE <br /> <br />b DEDUCTIBLE <br />,X I RETENTION <br /> <br />040972979 <br /> <br /> I COMBINED SINGLE LIMIT I: 1,000,000 <br />07/31/05 07/31/06 (Eaaccrdent) <br /> I BODilY INJURY <br /> (Per person) <br /> I BODilY INJURY $ <br /> (Per accident) <br /> 'I PROPERTY DAMAGE ,. <br /> (Per accident) <br /> AUTO ONLY - EAACCIDENT . <br /> - <br /> OTHER THAN EAACC . <br /> AUTO ONLY: AGG . <br /> EACH OCCURRENCE '1,000,000 <br /> f------ <br />07/31/05 07/31/06 AGGREGATE '1,000,000 <br /> ~ . <br /> . <br /> - <br /> . <br />, X ',T8'~/ ~/~,Ws 'I IU~R <br /> r <br />11/28/04 11/28/05 I EL EACH ACCIDENT '100,000 <br /> E.L. DISEASE - EA EMPLOYEE '100,000 <br /> E.L. DISEASE. POLICY LIMIT .500,000 <br /> lPPRovci; , i;' rUfUVi <br /> ,---a.'...> .(....;. <br /> <br />A <br /> <br />040972979 <br /> <br />I NOT APPLICABLE <br /> <br />$0 <br /> <br />B <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />~~Etl~t5~:5v~~16~S below <br />OTHER <br /> <br />, WC50548357 <br /> <br />I <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Certificate holder is listed as additional insured as per contractual 1~/~' 0 'p' ,{",,- <br />obligation. /Faxed 714-647-5406. SEE REVISED WC INFORMATION. ___ -:;:z./JL/".I-,...L.lf~'- <br />I' l~,tldt, :'-.l'\' ~I..c'cd\ <br />\ <,bl:'.il: ("it:.' .\1:'1:-'1.\ <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />SANTAAN <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP1RATl0 <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> <br />City of Santa Ana <br />Linda Kelley <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br /> <br /> <br />@ACORD CORPORATION 1988 <br /> <br />ACORD 25 (2001/08) <br />