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CERTIFICATE OF INSURANCE <br />artl � ire Insurance Company Ne- rk Underwriters Insurance Company <br />` artfoi u Accident and Indemnity Company Twi.- Aty Fire Insurance Company <br />+ <br />INSURANCE GROU P Citizens Insurance Company of New Jersey <br />#a y HARTFORD. CONNECTICUT <br />Co. Code <br />This to erta 't w --company � i ji-at <br />herein by-Co. ode- is uec 'to the. z� zxi su "r c1'� Narned Insured and Address <br />the policies enumerated bet w. <br />Saddleback Inn, Santa Ana, Inc. <br />- � <br />1650 - a i Street <br />r L lyr h f If Santa <br />California <br />The policies indicated herein apply with respect to the hazards and for the coverages and limits of liability indicated by <br />specific entry herein but this certificate of Insurance does not amend, extend or otherwise alter the terms and conditions <br />of the insurance coverage in the policies identified herein. <br />Coverages and Limits of Liability <br />{SINGLE LIMIT) <br />Policy Number <br />Hazards <br />and <br />Bodily Injurer and <br />Property Damage Liability <br />Policy Term <br />General Liability <br />72 CBP80o 1 1.6 <br />Premises-Operations <br />_ _ /73. —'.7 -: <br />Independent Contractors <br />72C.BP800116 <br />NOS <br />7/30/73-76 <br />Completed Operations, <br />7/30/73-76 <br />Products <br />72CBP800116 <br />Contractual (as described <br />below) <br />Automobile Liability <br />Owned Automobiles <br />Hired Automobiles <br />Nora -Owned Automobiles <br />Workmen's Compensation <br />and <br />Employers' Liability <br />Umbrella Liability <br />Coverages and Limits of Liability <br />{SINGLE LIMIT) <br />$ 000s <br />UAL LIMI'T'S) <br />NO <br />Bodily Injurer and <br />Property Damage Liability <br />Bodily Injury <br />each Pearson <br />}000 <br />, o <br />, 000 <br />Aggregate: <br />Liability Property Damage <br />*each *eacb. <br />occurrence occurrence <br />,000 ,000 <br />,000 , 000 <br />x 000 x000 <br />,000 XXXX <br />Liability <br />aggregate <br />,000 <br />, 000 <br />, 000 <br />XXXX <br />*each <br />occurrence <br />aggregate <br />o ,000 <br />o ,000 <br />NOS <br />300 000 <br />00q$ <br />, 000 <br />000 <br />s 'inn 000 <br />#000 <br />$ 000s <br />,000 <br />NO <br />XXXX <br />,000 <br />,0001 <br />3 XXXX <br />,000 <br />x000 <br />XXXX <br />8 000 <br />,000 <br />,0008 <br />000 <br />,000 <br />7000 <br />XXXX <br />x000 <br />1000 <br />XXXX <br />,000 <br />,000 <br />XXXX <br />Compensation -- Statutory <br />Employers' Liability — ,000 <br />a 000,000 <br />;elf Nvith respect to Automobile Liability the Policy Number entered above includes the symbol GB, AZ, MVP, MAG or PGB, the word "occurrence if <br />is amended to read "accident". <br />Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and <br />date.) Pedestrian idg at Saddleback Inn, Santa Ana, Cali o a, <br />If policy is canceled, 3 o days City o f Santa .fin <br />written notice will be given to: /o City Attorney <br />20 Civic Center la <br />Santa Ana, California <br />x5 � <br />`. r o <br />]date 12/18/73 .. .. ... ...... ......... ... ... .... yam' ...... . . .... . . .......... . <br />Form AL-12-2 Printed in U. S. A. 9270 <br />