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<br />. <br /> <br />.A~('~_ CERTIFICA1.,.; OF LIABILITY INSU~Ci;~M_~6 I DATE (MMlDDNY) <br />11.' 09/19/02 <br />~DUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />WILLIAMS INSURANCE BROKERS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />609 N. Harbor Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Fullerton CA 92B32-1596 <br />Phone: 714-526-55BB Fax:714-526-44B7 INSURERS AFFORDING COVERAGE <br />INSURED INSURER A: North American Elite <br /> INSURER B: NIAC <br /> Shelter for the Homeless INSURER c: <br /> 15161 Jackson Street INSURER 0: <br /> Midway City CA 92655 <br /> I INSURER E: <br /> <br />COVERAGES <br /> <br /> - <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEOTD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />AtfY 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 />INSR TYPE OF INSURANCE ___. P~LlCY~!~R_._ ~9!- fX l?r:fECTIVE POLICY EXPI~ ~-,-_____~I~~~,~__._-_. <br />LTR .- DATE MMlDDIYYI DATE fMMlqL --- <br /> ~NERAL LIABILITY EACH OCCURRENCE $1,000,000 <br />B X COMMERCIAL GENERAL LIABILITY 200201431NPO 05/19/02 05/19/03 FIRE DAMAGE (Anyone fire) $100,000 <br /> I CLAIMS MADE ~ OCCUR MED EXP(Any one person) $10,000 <br /> ...!. liquor 1iab PERSONAL & ADV INJURY $1,000,000 <br /> _ 1,000,000 GENERAL AGGREGATE $3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS ~ COMP/OP AGG $1,000,000 <br /> 4, '11 PRO- n, <br /> POLICY JECT LOC <br /> AUTOMOBILE LiABILITY COMBINED SINGLE LIMIT <br /> - $1,000,000 <br />B ...!. ANY AUTO 200201431NPO 05/19/02 05/19/03 (Eaaccidenl) <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS (Perpe~) <br /> - <br /> ...!. HIRED AUTOS BODILY INJURY <br /> $ <br /> ...!. NON-DWNED AUTOS {Per accident) <br /> -------- <br /> - API' [ROVED A~ ip~~dj;~'it1VJ $ <br /> ~~. LIABILITY )'''' AUTO ONLY. EA ACCIDENT $ <br /> ANY AUTO ;/ JL EAACC $ <br /> ::r,;, OTHER THAN - <br /> / AGO $ <br /> :.5~SS LIABILITY Dep ty City Attorn _EACH OCCURftENCE , <br /> OCCUR D CLAIMS MADE AGGREGATE $ <br /> $ <br /> =1,DEOUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND __11o~YJ.lMrr~J _ . 10l:t, , ____ ----- <br /> EMPLOYERS' LIABILITY E.L. EACH ACCIDENT I $ <br /> E.L. DISEASE - EA EMPLOYEE $ <br /> E.L. DISEASE. POLICY LIMIT $ <br /> OTHER <br />A Building CWBOOO0673-00-01431 05/19/02 05/19/03 Spec Form Bee below <br /> Replacement Cost Deductib1 $2,500 <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br />cert holder " its officers, employees, agents " representatives are named as <br />add'l insureds with regard to liability per A/I form attached for: <br />105 S. Birch St. , at $94,000, 426 S. Birch St. at $240,000 and 51B S. Birch <br />St. , at $141,000 and 1921 W. Washington at $2B3,000 in the city of Santa <br />Ana, Ca. *10 day notice for non-payment. xxx pw Revised 9/19/02 <br />CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> CITYOFA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> City of Santa Ana, Community DATE THEREOF, THE ISSUING INSURER WILL-t:I~DtA..5f{ TO MAIL *30 DAYS WRITTEN <br /> Development Agency (M-25) NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT ,81:1', f Jl' .~'" T............ iQ il>lAU <br /> CDBG Grant, John Maloney IMr 65f: I~~ 6BLlBMI8tl 8rt L:1.!r5ILIT . ar . "u ItlrlB~U lilt IUStlR~R.IT.5 AG~14"3 OR <br /> P 0 Box 19BB /"\ /\ <br /> Santa Ana, CA 92702 AEOPRE!.JtlffATlvl!!.5. <br /> I Pat White o fA ~:-: <br /> <br />ACORD 25-5 (7/97) <br /> <br />@ACORDCORPORATION 1968 <br />