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t <br />i DATE <br />A OORD, CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 07/01/2008 <br />PRODUCER 877-545-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Y;1�.�=iE Norti. America, inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />2c Century Blva. <br />i <br />F. C. Box. 305191 NAIL# <br />Nashv- 1'-e, TN �7230519' - - INSURERS AFFORDING COVERAGE <br />-- ''CO929-001 <br />INSURED Ta- er San Jose �_,=�>-�� INSURERL_ American Unity Grouc :.td <br />4B0 South BataV].c INSURERE — <br />Orange, CA 5286E /�i1 /��% <br />(- ,} � �%� INSURER C <br />INSURER" <br />INSURER E <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO' ICl' PERIOD INDI I -SATE MAY BE <br />OF, <br />ANY REQUIREMENT. TERM OF CONDITION OF ANY CONTRACT OR OTHER DOCUINENT WITF- RESPECT TC VVHICH THIE CERTI ICATE IvA1' BE ISSUEC OF. <br />MAY PERTAIk THE INSURANCE AFFORDED BY THE PO: :ICIES DESCRIBEL HEREIN IS SUBJECT TC' ALL THE TERMS EXC�USIDNE AND CONDITIONS OF SUCP <br />POJCIES. AGAR —ATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID C-AIMS. <br />NSR WDD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br />NS NSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDDh'Y. DATE MMIDDIYY <br />UNI-CGL-08-01-024 6i30i2008 6 / 3 0 / 2 0 0 R - 2, 000,00 <br />A GENERAL UABfLITY -G1 <br />NTED <br />PREMS is (Ea Occurence c <br />}; COMMERCIAL GENERA_ LIABfJT <br />MED EXP (Any one personS <br />CLAIMS MADE }; OCCUR <br />PERSONA- bAD\'INJUR: 2,000,00' <br />IGENERALAGGR=GAT- <br />PRODUCTS-COMPIOPAGG S <br />GEMAGGREGATE LtM',�AP°USE PE'r.., <br />ERG <br />� PO�IC1 JLO; <br />SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />,— <br />(1 <br />1 aac iden: <br />AN AJT C <br />irc <br />�w <br />��� <br />f>'_L OWNED AUTOS <br />TO <br />BODI 1 INJJR" <br />v l' <br />!Pe'perspn <br />¢ HEDULED ALTOS <br />Ir �'� <br />R� <br />BODIc <br />HIR DA'JTOS <br />— <br />lFe�acccp do enny. <br />NDN-OWNED A'J70c <br />7 <br />SF `• P't,�D' <br />PROPERTI' DAMAGE c <br />ONL1 - <br />GARAGELABILITY <br />- <br />OTH THAN <br />AN.., AJTC. <br />I t <br />AL70 ON_" AC,.^ c <br />EA"H D"CURREN^= <br />EXCESSIUMBREL`A. LIABILITY <br />AGGREGATE <br />OC�JF: CLAIMS MADE <br />DE'DJ�TIB_E <br />S <br />RETENTION 5 <br />W-. STA.T- IOTH- <br />WORKERS COMPENSATION AND <br />T ORY LIMITS <br />EMPLOYERSLIABILITY <br />E.L. EACH ACCIDENT <br />ANt' PROPRiETORIPARTNERi=XECUTIVE '. <br />EL DISEASE-E1.EMPLOYEEIc <br />O= FICERIMEMBER EXCLUDED` <br />I- vet oescme uno, <br />- _. DISEASE - POLIO`"_IMI- <br />SP ECIA'_ PRDVISIDNS be'01' <br />OTHER <br />DESCRIPTION OF OR E RATIONSILOCATIONSNEHI CLESIEXC LUS IONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />The Certificate Holder is named as Additional Insured by endorsement to the Policy subject to the <br />terms set forth in the endorsement. <br />Taller Sara Jose, Block Grant - 810 N. Poinsetta, Santa Ana, CA 92701 <br />CERTIFICATE HOLDER UANUtLLA I III IV <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF. THE ISSUING INSURER WILL ) KX(XMAIL 3 D DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF>X"XZN16KXffbHC46)ftXKL <br />Santa Ana Work Center p }q {y <br />iDOC E. Santa Ana Blvd. AUTHORIZED REPRESENTATIVE <br />Suite 2000 iI -'II !'� I <br />Santa Ana, CA 92701 <br />.on n�n9F m,-,l •7 QR 54R rpP-t 10969936 ©ACORD CORPORATION 1988 <br />