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AC RD CERTIFICATE OF LIABILITY INSURANCE CSR pF <br />SYMCO-1 DATE (MMI00/YYYY) <br />06 16 Ofi <br />P DuGER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hurnette Inaurance Agency, Inc. <br />3447 Lawrenceville Suwaaee Rd. HOLDER. THIS CERTIFICATE DOEB NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />Suwaaee GA 30024-2402 <br />Phoae:770-339-8888 Fax:770-339-1442 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />5 <br />l <br />~ INSURER A: Zurich II.S. Insurance ' <br />~'-/ <br />a <br />"~DO <br />f INSURER B: Le ion Insurance Com an <br />A p2~7 - /~~ <br />Iac <br />G <br />S INSURER C: <br />. <br />rOnp. <br />ymCO <br />105 Satellite Blvd. Suite 5 ' INSURER D: <br />Suwaaee GA 30024 <br />INSURER E: <br />V 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 CONTRACTOR OTHER DOCUMEN T WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN L4 SUBJECT TO ALL THE TERMS, E%CLUSIONS AND CONDHK)NS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BV PAID CLAIMS. <br />POLICY NUMBER <br />LTR TYPE OF INSURANCE ~~~EFF`EZ`YN€?F6lTCPFXiMRATIdN~- LIMITS <br />GATE MMIDD DATE MMR) <br />~GENEAAL LIABILITY <br />' EACH OCCURRENCE 81, OOO, QQQ <br /> <br />$ ~~ <br />07/31/06 O7 /31/07 $300 <br />000 <br />fAMMERCIAL GENERAL LIABILITY <br />040972979 <br />A PREMISES EaamlrencaS , <br />_ <br />CWMS wwE ~ OCCUR MED EXP (Any arse parson) $ LO, 000 <br /> PERSONALAAOV INJURY . $1,000,000 <br /> GENERALAGGREGATE $ 2,000, OOO <br />GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOPAGG~ $2,000,OOQ <br />X POLICY-l PEO LOC <br />AUTOMOBILE LIABILITY ~ COMBINED SINGLE L'MR <br />$ 1,000, 000 <br />A X ANYAUTD 040972979 ~ 07/31/06 07/31/07 QEaacciomH <br />ALL OWNED AUTOS BODILY INJURY $ <br /> <br />SCHEDULEO gUTDS <br />(Por ~~) - <br />X HIRED AUTOS BODILY IWURV <br />(Par accident) <br />$ <br />X NON-0WNED AUTOS ~ <br />~_ _ ..-.- _ - ~ PROPERTY DAMAGE $ <br /> (Per acd0ent) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ~ANVAUTO !NOT APPLICABLE orHERTHAN EA ACC Y <br /> AUTO ONLY: AGG ' $ <br /> EXLESSNMBRELLA LUIBILITY EACH OCCURRENCE ~ Y1, 000, 000 <br />A I X I OCCUR ~ CLAIMSMADE 040972979 O7 /31/06 O7/31/Q7 'AGGREGATE $ 1x000,000 <br /> ~' , $ <br /> DEDUCTIBLE $ <br /> X RETENTION $ O Y <br />WORKERS COMPENSATION ANO X TORY LIMfTS' ER' <br />' <br />B EMPLOYERS'LU8ILITV <br /> <br />ANY PROPRIETORrPARTNER/EXECUTIVE <br />WC50548357 <br />11/28/05 <br />11/28/06 <br />E.L. EACH ACCIDENT <br />Y 100, 000 <br /> OFFICERlMEMBER E%CLUOED? ~ - E.L. OISE~eEA MPE LDYE S ZOO, OOO <br />It yes ceecrioe weer <br />SPECIAL PROVISIONSEe1ow <br />I <br />E.L. DISEASE-POLICY LIMIT' $ 500,000 <br />~ OTHER <br />I <br />DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES! E%CLUSIONB ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />Certificate holder is listed as additional insured as per contractual <br />obligation./Faxed 714-647-5406. SEE REVISED WC INFORNAT20N. ~6%~ <br />CERTIFICATE HOLDER CANCELLATION <br />SANTAAN 5110UL0 ANV OF THE ABOVE DESORISED POLICIES BE CANOELLEO BEFORE THE E%PIRATIO <br /> DATE THEREOF. THEISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN <br />City Of Santa And NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, SUT FgILURE TO OO SO SNALL <br />L1IIda Relley <br /> <br />20 Civic Center Plaza IMPOSE No OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER, ITS AGENTS Oft <br />Santa Ana CA 92702 REPRESENTATIVES. <br /> AU D PRESE#7~1TIVE <br />ACORD 25 (200'1108) ©ACORD CORPORATION 1988 <br />