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<br />From: Kellie To: Clerk of City Council <br /> <br />Date: 111812006 lime: 12:44:12 PM <br /> <br />Page 2 of3 <br /> <br />ACORD <br />"" <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />1 DATE (MMlDDM'YV) <br /> <br />I 01/1812006 <br /> <br />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 /> <br />PRODUCER <br />Dickerson Agency,lnc. <br />3185 Cherokee Street <br />Suite 400 <br />Kennesaw GA 30144 <br />INSURED Group 1 Solutions, Inc <br />8950 Brixton Place <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />NAlC# <br /> <br />A- ;}.f)o5 -.;L!p <br /> <br />INSURER A <br />INSURER B <br />INSURER C <br />INSURER 0 <br />INSURERE: <br /> <br />HARTFORD CASUALTY COMPANY <br /> <br />Suwanee GA 30024 <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 />MlV REQUIREMENT, TERM OR CONDITION OF AN'( 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 />INSR ~~f M.. POUCY EFFECTIVE PS!~!EY,EXPIRATlON <br /> POUCY NUMBER LIMITS <br /> ~NERAL LIABILITY EACH OCCURRENCE 1 <br /> f- 5MERCIAL GENERAL LIABILITY 1 <br /> f- CLAIMS MilDE D OCCUR MED EXP M" one "erson) 1 -- <br /> PERSONAL & fJDV INJURY 1 <br /> GENERAL AGGREGATE 1 <br /> n~ AGGREn \IMIT APPn PER PRODUCTS COMP/OP AGG 1 -.. <br /> POLICY ~E.9; LOC <br /> ~UTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 <br /> f- !\.Ny AUTO [Eaaccioenl) <br /> r- ALl. OWNED AUTOS BODILY INJURY <br /> (Per person) 1 <br /> f- SCHEDULED AUTOS <br /> f---: HIRED AUTOS BODILY INJURY 'I <br /> NON-OWNED AUTOS (Peri'lccident) <br /> f-- <br /> f- I),' O. PROPERTY CAMAGE 1 <br /> [Peraccioenl\ <br /> H~G. L","ILITY 70\j~ j' / AUTO ONLY - EA ACCIDENT 1 <br /> !\.Ny AUTO EAACC 1 <br /> OTHERTW\.N <br /> AUTO ONLY: AGG 1 <br /> ~SSNMBREL~ LIABILITY i EACH OCCURRENCE 1 <br /> OCCUR D CLAIMS MADE AGGREGATE 1 <br /> ,I _n~ <br /> ~ ~BDUCTlBLE 1 <br /> RETENTION , , <br /> WORKERS COMPENSATION AND X I WCSTATU-.I 10TH- <br />B EMPLOYERS' LIABILITY 20WECKZ6525 09/1812005 09/16/2006 1100,000 <br /> ANY PROPRIETORiPARTNERIEXECUTIVE EL EACH ACCIDENT <br /> OFFICERlMEMBER EXCLUDED? EL DISEASE EA EMPLOYEE 1100,000 <br /> Iryes.d€scribeunder , 1500,000 <br /> SPECIAL PROVISI(t>.IS below , E.L. DISEASE. POLICY LIMIT <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES J EXCLUSIONS ADDEO BY ENDORSEflENT (SPECIA1. PROVISIONS <br />fax 714-647.6956 <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />Clerk of City Council <br />Cily of Santa Ana <br />20 Civic Center Plaza(M.30) PO Box 1888 <br />Santa Ana, CA 32702.1988 <br /> <br />SHOULD AN'{ OF THE ABOVE OESCRlBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATlON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATlVES. <br />AUTHORIZED REPRESENTATIVE <br /> <br /> <br /><KJA> <br /> <br />ACORD 25 (2001108) <br /> <br />@ACORDCORPORATION 1988 <br /> <br />c~ <br /> <br />.'- <br />