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CERTIFICATE OF <br />R LIABILITY INSURANCE CSR PF DATE (MMA)D/YYVY) <br />D <br />.CO - :SYMCO-1 12 13 06 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Bu`rnette Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3447 Lawrenceville Suwaaee Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Suwaaee GA 30024-2402 <br />Phone: 770-339-8888 Fax:770-339-1442 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED A-/L~6-.~~ INSURER A: Zurich U. S. Insurance <br />~ <br />_ X34 INSURER B: Le ion Insurance Com an <br />~ <br />~ _Q INSURER C: <br />$ CO GiOIIp Iac• <br />105 Satellite Blvd. Suite S INSURER D: <br />Suwaaee GA 30024 <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAV 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 BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDO GATE MM/OD LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br />A X COMMERCIAL GENERALLIABILITV 040972979 07/31/06 07/31/07 PREMISES Eaoccurence $ 300, 000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10, OOO <br /> PERSONALB ADV IWURY $1,000,000 <br />' GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 <br /> X POLICY PECOT LOC <br /> <br /> AUT OMOBILE LIABILITY COMBINEDSINGLE LIMIT $1,000,000 <br />A X aNV AUrD 040972979 07/31/06 07/31/07 (Ea eccidenq <br /> <br /> ALL OWNED AUTOS BODILY IWURY $ <br /> (Par parson) <br /> SCHEDULED AUTOS <br /> ~ <br /> X HIRED AUTOS BODILY INJURY <br />$ <br /> (Pereccitlant) <br /> X NON-OWNED AUTOS <br /> <br /> PROPERTY DAMAGE $ <br /> I, (Per acddent)- <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> <br /> ANV AUro NOT APPLICABLE OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSNMBRELLA LIAEILITY EACH OCCURRENCE $1,000,000 <br />A X OCCUR ~CLAIMSMADE 040972979 07/31/06 07/31/07 AGGREGATE $1,000,000 <br /> <br /> $ <br /> OEDVCTIBLE $ <br /> <br /> X RETENTION $ O $ <br /> WORMERS COMPENSATION AND X TORY LIMITS ER <br />B EMPLOYERS'LIABILITY WC50548357 11/28/06 11/26/07 E.L. EACHACaoervr $100,000 <br /> ANY PROPRIETORlPARTNERiEJ(ECUTIVE <br />OFFlCERIMEMBER EXCLUDED? <br />E. L. DISEASE-EA EMPLOYE <br />$lOO, OOO <br /> Ifyes, tlescnbe antler <br />SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $500,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Certificate holder is listed as additional insured as per contractual <br />obligation./Faxed 714-647-5406.SEE REVISED WC INFORMATION. <br />reennrnx unr nco CANCELLATION <br /> <br />' SANTAAN BHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O GAYS WRITTEN <br />City of Santa p~pA3T7T~T~ ^ / <br />`/ ~~ <br />~ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Linda Relley ` ~~ 1 1~-,J <br />~ <br />-~ ~5 i C~ ~` l~ pOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, RS AGENTS OR <br />20 Civic Center P1aZa <br />';~ <br />CA 92702 REPRESENTATIVES. <br />~~ <br />Santa Ana <br />~ AU D PRESEp~fpTVE <br />/ <br />1i,~ / <br />~ <br />ACORD 25 (2007108) Aron Lain ll(y nt[UTRCy ~n~.unu wnrvnn uvrv moo <br />