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asoofvy <br />CERTIFICATE OF LIABILITY INSURANCE D^T066n22112rh <br />r12 <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 policy(les) must be endorsed. If SUBROGATION IS WANED, 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 />certlfles holder In lieu of such endorsem s . <br />pwoouO 310$32-1131 E. <br />Modem Insurance, Inc. PHONE FJ`Ir Ne <br />Arroyo Insurance Services Y ` <br />333 W. Sth SL, P.O. Box 1031 E, 0. HOOPEA <br />San Pedro, CA 90733-1031 <br />INSU S APFORDIN -OVERAGE NAIL 2 <br />1,17ft—mas IP Hag <br />INaURED Sam Hooper S Associates INSURER w: Hartford Mutual Insurance Co 29424 <br />Sam Hooper INSURER a: <br />17316 Edwards Rd Ste 8100 oIBURIER c <br />Cerritos. CA 90703 WSURERD: - <br />GOV ERAC+CS ...r=rte . rrrv,+. .�...�....�. -. PERIOD <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED T WITH RESPECT TO NAMED ABOVE FOR THE POLICY <br />OR OTHER DOCUMENWHICH THIS <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT <br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED <br />POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ <br />EXCLUSIONS AND CONDITIONS OF SUCH <br />N TYPE oP INSURANCE POUCY NUMBER N <br />LIYITS <br />1 <br />GENERAL UABILnY <br />X X 72SSSMAJ9140SC 0112W12 01!28/13 <br />EACH OCCURRENCE S •000.00 <br />pREM s _ 300. <br />A X COMMERCUV_ GENERAL LIABILITY <br />MED EXP ons INJUR S 10.00 <br />CLAIMS -MADE rX OCCUR <br />PERSONAL S ADV INJURY S -1, .00 <br />— '-- <br />GENE RAL AGGREGATE S 2.000• 0001 <br />PRODUCTS _C,AGG S 2.004) ruwa <br />GENL AGGREGATE LOMn APPLIES PER - <br />f <br />X POLICY PRO -LOC _ <br />-- <br />- <br />COMBINED SINGLE LIMIT S 1.000.0 <br />AUTOMOBILE JABILITY <br />(Er 64.IM) <br />ANY AU`fO <br />BODILY INJURY (Per Por>•en) S <br />ALL OWNED AUTOS <br />BODILY IMI JRY (Par attidaM) 5 <br />SCHEDULED AUTOS <br />72SSBMAJ9140SC 01/28/12 01/26/13 <br />PROPERTY DAMAGE s <br />(P.r ckIanl) <br />A X HIRED AUTOS <br />T2SSBMAJ9140SC 01122 01/2W13 <br />i <br />A X NON-OVVNEDAUTOS <br />UMBREl1A LIAR OCCUR ///III /y �j <br />Y <br />EACH OCCURRENCE S _ <br />AGGREGATE <br />EXCESS LWB CLAMIS-MADE �0./ <br />S -. <br />DEDUCTIBLE <br />YJ" <br />NIA <br />r •. t <br />- <br />rT� c r n•SF1SF <br />DP3QrIPT10N OF OPERATIONS r LOCATIONS I VEHICLES IAtYN ^CORD 101. Addrdoml Reals ScrMduN. M Ines "Mc. a MCFAred) <br />City of Santa Ana• its officers employees,agents,voluntaere, and <br />representatives are Additional Insured Including primary and non <br />eontrtbutory wording form SS00804061 mut only as respects to the <br />overedl by this a <br />CERTIFICATE HOLDER CANCELLATION <br />CLECSAI <br />SHOULD ANY OF THE ABOVE DI <br />THE EXPIRATION DATE THE <br />Clerk of the City Council ACC RD n H THE POL <br />City of Santa Ana <br />20 Civic Center Plaza (MJO) wu <br />PO Box 1986 0 g ns, <br />Santa Ana, CA 92702-1988 <br />® 1988-2 AOR <br />C <br />ACORD 26 (2009109) The AC ORD name a ogo are registered mar ` of ACORD <br />POLICIES BE CANCELLED BEFORE <br />XTICE_ WILL BE DELIVERED IN <br />All rights reserved. <br />