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