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~'wcl i1~3~~~~( <br /> Policy Number: AO924-75-24 Date Entered: 11/24/2009 <br /> ACORD,~ CERTIFICATE OF LIABILITY INSURANCE DATE,MNVDD/YYYY) <br /> 11/24/2009 <br /> <br /> •ROOUCSR Brad Hume Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> 22821 Lake Foreat Drive, #11$ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Lake Forest,Ca 92630 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Phone: (949)830-7970 <br /> Fax: (949) 830-9746 INSURERS AFFORDING COVERAGE NAIC # <br /> <br /> NSURED SPECIALTY ENVIRONMENTS CO, INC INSURERA:FARMER9 INSURANCE EXCFlANGE <br /> INSURER B:MID CENTURY INSVRANCE COMPANY <br /> 2$20 S BROADWAY INSURER C: <br /> SANTA ANA, CA 92707 INSURER D: <br /> INSURER E'. <br /> <br /> :OVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br /> J$R AOD'L POLICY EFFECTIVE POOCY E%PIRATION <br /> <br /> .T POLICY NUMBER LIMITS ' <br /> GENERAL LIABILITY EACH OCCURRENCE $1 OOO OOO <br /> <br /> ) X COMMERCIAL GENERAL LIABILITY D TO D <br /> PREMISES Ea Dccurence $ <br /> CLAIMB MADE ~ OCCUR 60469-68-12 11/17/2009 11/17/2010 MED ExP (Any one person) $ <br /> PERSONALSADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> <br /> L ANV AUTO (Ea accitleni) $1, QQQ, QQQ <br /> ALL OWNED AUTOS 602629428 8/22 /2008 82/2010 BODILY INJURY <br /> SCHEDULED AUTOS (Per parson) $ <br /> MIRED AUTOS <br /> BODILY INJURY $ <br /> NON-0YJNED AUTOS ~O (Per accitlenQ <br /> PROPERTY DAMAGE $ <br /> (Par accitleni) <br /> GARAGE LIABILITY ~~o ! y~`O1 ;~D~n AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO ~ P~. AUTO ONLVN EA ACC S <br /> G Acc $ <br /> E%CESSIUMBRELLA LIABILITY •`Sta EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE ~y AGGREGATE $ <br /> S <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND WC STAN- OTH- <br /> EMPLOYERS' LIABILITY <br /> ANV PROPRIETOR/PARTNER/E%EGUTIVE E.L. EACH ACCIDENT $ <br /> <br /> ~ OFFICER/MEMBER E%CLUDED7 D924-75-24 8/1/2009 8/1/2010 E. L. DISEASE-EA EMPLOYEE 8 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E. L. DISEABE-POLICY LIMIT $ <br /> OTHER <br /> E$CRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVI$ION9 <br /> <br /> DDITIONAL INSURED: CITY OF SANTA ANA <br /> <br /> :ERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3__ DAYS WRITTEN <br /> 20 CIVIC CENTER PLAZA, M-25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SNALL <br /> SANTA ANA, CA 92701 IMPOSE NO OBLN3ATION OR LUIBILITY OF ANY KING UPON THE INSURER, ITS AGENTS OR <br /> REPRESENTATNEB. <br /> AUTHORIZED REPRESE IVE <br /> CORD 2$ (2007/08) ©ACORD CORPORATION 1988 <br /> <br /> ~tlucetl using Forms Bass Plus saNwara. www.FOrmsBOSa.com; Impressive Publishing 800-208-1977 <br /> <br />