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<br />. <br /> <br />~_.-f, <br />ACURDN CERTIFICA <br /> <br />OF LIABILITY INSU <br /> <br />DATE (MMIODNYVY) <br /> <br />10/28/2005 <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 /> <br />CE <br /> <br />PRODUCER (213) 787-1100 <br />Frenkel & Co., Inc. <br />725 South Figueroa St., <br />Su;,te 2200 <br />Los An e1es CA 90017 <br />INSURED <br /> <br />Lien On Me, Inc. <br />P.O. Box 91630 <br />Pasadena <br />COVERAGES <br /> <br />INSURERS AFFORDING COVERAGE <br />INSURER A: Hartford O/B <br />Lie. #0098170 INsuRERB:Tudor/Worldwide <br />INSURER c: <br />INSURER 0 <br /> <br />NAIC# <br /> <br />CA 91109-1630 <br /> <br />INSURER E <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NQT\IVITHSTAND1NG ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR ADD'l p~.N~~:~~~g'wf POLlCY EXPIRATION <br />LTR INSRD TYPE OF INSURANCE POLlCY NUMBER DATE (MM/DDIYY) LIMITS <br />A ~NERAl LIABILITY 72SBAAG7645 08/15/2005 08/15/2006 EACH OCCURRENCE . 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY ~~~~~~J9E~~~~nce\ . 300,000 <br /> I CLAIMS MADE ~ OCCUR / / / / MED EXP IAnv one DersDn) . 5,000 <br /> f- EBL PERSONAL & ADV INJURY . 1,000,000 <br /> f- / / / / GENERAL AGGREGATE . 2,000,000 <br /> n'L AGG~EnE LIMIT ArilES PER: PRODUCTS-COM~OPAGG . 2,000,000 <br /> POLICY ~g8T X LOC / / / / <br />A ~TOM08IlE LIABiliTY 72SBAAG7645 08/15/2005 08/15/2006 COMBINED SINGLE LIMIT 1,000,000 <br /> (EaaCCidenl) . <br /> f- ANY AUTO <br /> f- ALL OWNED AUTOS / / / / BODILY INJURY <br /> (Per person) . <br /> SCHEDULED AUTOS <br /> f- / / / / <br /> ~ HIRED AUTOS BODILY INJURY <br /> (PeraCCidenl) . <br /> ~ NON-OWNED AUTOS <br /> / / / / PROPERTY DAMAGE <br /> (Per aCCident) . <br /> ~~GE LIABILITY AUTO ONLY - EA ACCIDENT . <br /> ANY AUTO / / / / OTHER THAN EA ACC . <br /> AUTO ONLY: AGG . <br />A ~~SSlUM8RELLA LIABILITY 72SBAAG7645 08/15/2005 08/15/2006 EACH OCCURRENCE . 1,000,000 <br /> X OCCUR D CLAIMS MADE AGGREGATE . 1,000,000 <br /> . <br /> =j ~EDUCTIBLE / / / / . <br /> RETENTION $ 10,000 . <br /> WORKERS COMPENSATION AND / / / / I T~~-7I~JI~s I 10TH- <br /> EMPL.OYERS' LIABILITY ER <br /> ANY PROPR1ETOR/PARTNERIEXECUTIVE E.L EACH ACCIDENT . <br /> OFFICERfMEMBER EXCLUDED? / / / / EL DISEASE - EA EMPL.OYEE $ <br /> If yes, describe under <br /> SPECIAL PROVISIONS below EL.. DISEASE - POLICY LIMIT . <br />B OTHER Professional SPLOOO9778 03/25/2005 03/25/2006 Limit/Aggregate 1,000,000 <br /> Liability / / / / Deductible Per Claim 5,000 <br /> / / / / <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICL.ESlEXClUSIONS ADDED BY ENDORSEMENT/SPECIAL. PROVISIONS <br />The City of Santa Ana, It's Agents, Officers and Employees are named as additional insureds per the attached form. <br />*Except ten days notice of cancellation in the event of non-payment of premium. <br /> . "f' '_I' ~ fV, <br /> 1\1' j;,.,j .' <br /> <br />CERTIFICATE HOLDER <br />( ) <br /> <br />CANCELLATION <br />(714) _ 647 56t1 .',' SHOULD ANY OF THE <br />. Ai ~~f::~/.,Lr..L---J!/2~. <br />~~------"",~~:; : ./2~,\.\, <br /> <br /> <br />@ACORDCORPORATION1988 <br /> <br />City of Santa Ana ".,,". ,'~\ <br />Workers Compensation Claims <br />20 C;,v;,c Center~~L{M~41) <br />Santa Ana CA 92701- <br />ACORD 25 (2001/08) <br />9tn.o~ INS025 (0108).05 '.1 '~i~'2C'="'l::CTRONIC LASER FORMS. INC - (800)327-0545 <br /> <br />Page 1 of2 <br />