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AC R OP ID: F <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MiVDp/YYYr) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.) THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER_ <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polley(iea) must be endorsed, If SUBROGATION 13 WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such andOrRamer.Nm1 <br />310-832-1131 <br />Modem Insurance, Inc. <br />Arroyo Insurance Services <br />333 W. 5th St., P.O. Box 1031 <br />San Pedro, CA 90733-1031 <br />Sam Hooper S Associates <br />Sam Hooper <br />17316 Edwards Rd Ste 8100 <br />Cerritos, CA 90703 <br />COVERAGES rrrarrcrr Arc u. rues.._ <br />Co <br />REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />N <br />TYPE OF INSURANCEman <br />O ea. LIABILITY <br />r+O JCY NUMBER <br />Y <br />M <br />DMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE S <br />ISE $ <br />c----- O OCCUR <br />MED EXP (Any q person) f <br />I <br />PERSONAL & ADV INJURY i <br />GENERAL AGGREGATE f <br />GENL AGGREGATE LIMIT AP PLIES PER: <br />PRODUCTS-COMP/OP AGO f <br />POLICY m LOC <br />AUTOMOBILE LWBILnY <br />ANY AUTO <br />_ ^- <br />_ <br />J <br />S <br />COMBINED SINGLE LIMIT <br />(EB aeeldenU f <br />ALL OWNED AUTOS <br />BODILY INJURY (Per person) S <br />SCHEDULED AUTOS <br />BODILY INJURY (Per --d—) S <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE f <br />(Per etridod) <br />i <br />S <br />UMBRELLA LIAR <br />EXCESS LSAB <br />OCCUR <br />C.' ISMADE <br />EACH occVRRENCE i <br />AGGREGATE f <br />OEDVCTIBLE <br />A <br />N 5 <br />AND EMPLOYERS'LI ATON <br />AND EMPLOYERS' LIABILnY <br />IN <br />OFFICER IEM—EAXCLUDED ECUTNE Y� <br />(Mandatory M NH) <br />M yyeea, daambe under <br />OES RIPTION OF OPERATIONS <br />N/A <br />72WECJX2201 <br />01/26/12 <br />01!2613 <br />f <br />S <br />X WC 3TATV- OTH- <br />EL EACHACCIDENT f 1.000,00 <br />EL. DISEASE - EA EMPLOYE f 7.000,00 <br />E. L. DISEASE - POLICY LIMrI S 1.000.00 <br />DESCRIPTgN OF OPERATIONS I LOCATIONS I VEHICLES (A—.h ACORD 101, AddItbo-1 Rem Schedule, N mora apace Ia regoAmd) <br />Clerk of the City Council, City of Santa Ana, its officers, <br />employOOS,agents.voluntsere, and representatives are Certificate Holder. <br />CERTIFICATE "^K nco <br />Clerk of the City Council <br />City of Santa Ana <br />20 Civic Center Plaza (M-30) <br />PO Box 1988 <br />Santa Ana, CA 92702-1988 <br />ACORD 25 (2009/09) <br />CLECSAI <br />The ACORD name and <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE NRTH THE POLICY PROvISIoNS_ . <br />are registered marks of <br />All rights <br />