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'4?? °® CERTIFICATE OF LIABILITY INSURANCE TE / 1 OS 15 201 2 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONALINSURED,the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MOURER-FOSTER SNC/PHS ON 151520 P A NO Ea: (866) 467-8730 1a/c, NOI: (704) 921-4658 : (866)467-8730 Fc (704)921-4658 E-MAIL PO BOX 2 9 6 11 ADDRESS: CHARLOTTE NC 2 8 2 2 9 TOMER ID p: INSURER(S) AFFORDING COVERAGE NAIC p /NSUREO INSURER A S'2IIt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oL/GY XP /MM/00/YYYY/ L/M/TS GENERAL L/AB/L/TY EACH OCCURRENCE 3 2 O O O O O O COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence) 5 1, 0 0 0, 0 0 0 A CLAIMS-MADE ? OCCUR MED EXP IAny one person) 5 1 O , O O O X General Liab 81 SBA SR4222 02/16/2012 02/16/2013 PERSONAL&ADVINJURY 9 2, 000, OOO GENERAL AGGREGATE 9 4, 0 0 0 r O O O EN'L AGGRE ATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG 5 4, O O O r O O O ? PRO- ? POLICY LOC S A[/T OMOB/LE L/AB/L/TY COMBINED SINGLE LIMIT (Ea eccitlent) s ANY AUTO BODILY INJURY (Per parson) 5 ALL OWNED AUTOS BODILY INJURY (Per accident) 9 SCHEDULED AUTOS PROPERTY DAMAGE 5 HIRED AUTOS (Per accitlentl NON-OWNED AUTOS ? 9 UMBRELLA L/AB OCCUR EACH OCCURRENCE 9 EXCESS L/AB CLAIMS-MADE AGGREGATE 9 DEDUCTIBLE 9 RETENTION 5 9 WORKERS GOMPENSAT/ON WC STATU- OTH- ANO EMPLOYERS' L/AB/L?Y , T RY LIMIT ER ? / N ANY PROPRIETOR/PARTNER/EXEC UTIVE? OFFI R M M N/A E.L. EACH ACCIDENT 9 / BER EXCLU DEDP a CE E /Manda[ory m NM/ E.L. DISEASE - EA EMPLOYE 9 If yes, Describe und¢r DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 9 OESCR/PT/ON OF OPERAT/ONS / LOCAT/ONS / VEH/CLES /Attach AGGRO )O 1, Addi[iona/ Ramai*s Se/redu/e, iI more space u iaOUiiad/ A?O??? i? ; Those usual to the Snsured's Operations. 'i'gRES:1 1 ..1 %DD CERTIFICATE HOLDER CANCELLATION ???? `?????_1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The City Of Santa Ana BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 2 O C1V1C Center Plaza DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1 9 S 8 A(/TMOR/ZED REPRESENTAT/VE SANTA ANA , CA 9 2 7 0 2 ?a-i_ ?a_.?C.4,..?? ® 1 988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD