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<br />ACQ/JD.. CERTIFICATE OF LIABILITY INSURANCE CSR PF I DATE (MMfDOIYYYY) <br />SYMCO-1 06/16/06 <br />PRODUCER 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 AFFORDED BY THE POLICIES BELOW. <br />Suwanee GA 30024-2402 <br />Phone: 770-339-8888 Fax:770-339-1442 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED ,4 - ;)004:'- i 5 ') INSURER A: Zurich u.s. Insurance <br /> INSURER B: Legion Insurance Company <br /> sowca Group, Inc. INSURER c: <br /> 1 5 Sate11~te Blvd. Suite 5 I INSURER 0: <br /> Suwanee GA 30024 I 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 /> I ~9..';!nJ=~hf5mIE ! Pgk\-1YI~rl1hRD}~!gN I -- <br />L TR NSR TYPE OF INSURANCE POLICY NUMBER LIMITS <br />AI GENERAL LIABILITY l~~~OCCURRENCE $1,000,000 <br />Xl COMMERCIAL GENERAL LIABILITY 040972979 07/31/06 07 /31/07 PREMISEs'(E~~~~u<:~nce} $ 300, 000 .,- <br /> ~ CLAIMS MADE C!J OCCUR MED EXP (Anyone person) $10,000 <br /> PERSONAL & ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APnS PER: PRODUCTS - COMP/OP AGG : $ 2,000,000 <br /> !Xl ( 11 PRO I <br /> X POLICY JECT ' LaC <br /> AUTOMOBilE LIABILITY ~MBINED SINGLE LIMIT <br />A .~ ANY AUTO 040972979 07/31/06 07/31/07 (EaaCCldent) $1,000,000 <br /> ~ ALL OWNED AUTOS BODILY INJURY <br /> (Per person) $ <br /> SCHEDULED AUTOS <br /> - <br /> ; X HIRED AUTOS BODILY INJURY 1$ <br /> e--, <br /> n NON...QWNED AUTOS {Per accident} <br /> :--- <br /> I-I --------1 . PROPERTY DAMAGE :$ <br /> (Peraccidenl) i <br /> I RRAGE LIABILITY I I AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO I NOT APPLICABLE OTHER THAN EA Ace $ <br /> AUTO ONLY AGG I $ -,- <br /> I IfJESSIUMBRELLA LIABILITY ! EACH OCCURRENCE $1,000,000 <br />A X ,--, 040972979 07/31/06 07/31/07 $1,000,000 <br /> OCCUR ----.--J CLAIMS MADE , AGGREGATE <br /> I <br /> I I ,$ <br /> -- <br /> 8 DEDUCTIBLE $ <br /> X RETENTION $0 '-- <br /> $ <br /> WORKERS COMPENSATION AND X ITORY LIMIT:;; I IUER-' <br />B EMPLOYERS' LIABILITY WC50548357 11/28/05 11/28/06 $100,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $100,000 <br /> If yes, describe under POLICY LIMIT i $ 500, 000 <br /> SPECIAL PROVISIONS below E.L. DISEASE - <br /> OTHER <br /> I I i I <br />DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Certificate holder is listed as additional insured as per contractual <br />ob1igation./Faxed 714-647-5406.SEE REVISED WC INFORMATION. 7B-3 <br /> <br />CERTIFICATE HOLDER <br /> <br />SANTAAN <br /> <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <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 /> <br />City of Santa Ana <br />Linda Kelley <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br /> <br /> <br />@ACORDCORPORATION 1988 <br /> <br />ACORD 25 (2001/08) <br /> <br />l <br /> <br />