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FERGU-2 OP ID: MH <br />DATE (MMIDDIYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 7IT101/3012015 <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 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 endorsement(s). <br />PRODUCER <br />CONTACT <br />Melissa elissa Huson <br />Narver Insurance <br />641 W. Las Tunas Drive <br />. . ............. .... ... . ............ . . . ...... <br />PHONE FAX <br />(AIC N ®) 626 <br />j�,L, ,gx%626-943-2200 -299-1010 <br />PO Box 1509 <br />E'MAIL ............. . . . . ..... . .... . <br />ADDRESS. Mhuson@narvercorn <br />San Gabriel, CA 91778-1509 <br />........... .. ... .. ..... . ..... . . .. <br />Wesley G. Hampton <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />. .......... .. . . . . . ................... <br />INSURER A: Westport Insurance Corporation 39845 <br />......... . . . ... ....... <br />INSURED Law Offices of Ferguson, Praet <br />. . ........ . ...... ...... . <br />INSURER B <br />& Sherman, APC <br />.............. ... . . .. . . ..................... <br />1631 East 18th Street <br />INSURER C <br />. ........... . ..... <br />Santa Ana, CA 92705 <br />INSURER D..: .... . . ..... . . .............. . I . . . ......... <br />_OOMBINEDSINGLE LIMIT $ <br />INSURER E: . . . .. ....... . ..... .... . ................. .. <br />accidem) <br />BODILY INJURY (Per person) <br />.... .... ....... <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: PFVI.q!ON NUMBEPm <br />THIS IS TO CERTIFY THAT THE POLICES 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 <br />ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED <br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN <br />REDUCED BY PAID CLAIMS <br />........... . ...... . . . <br />NSR AbbLISUBR <br />LTR TYPE OF INSURANCE INSD MD POLICY NUMBER <br />. . ........................... <br />Poucy EFf: poucV ExP <br />fMMIDD/YYY LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />_n_LMMJDD1YYYY) <br />EACH OCCURRENCE $ <br />CLAIMS-MADF OCCUR <br />. ...... <br />. .... . <br />DAMAGE TO RENTED <br />PREMISES (Fa occurrence) ........ . . ......... .. <br />. .. . ......... . .. .. <br />MED EXP (Any one person) <br />.. ....... . ... ......... ... <br />PERSONAL& ADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />. . ..... . ... . ..... - I I . . . ....... - <br />GENERAL AGGREGATE $ <br />L <br />POICY JPE'COT- LOC <br />. . ...... ... ... ....... <br />PRODUCTS - COMP/OP AGG J $ <br />OTHER, <br />$ <br />AUTOMOBILE LIABILITY <br />_OOMBINEDSINGLE LIMIT $ <br />ANY AUTO <br />accidem) <br />BODILY INJURY (Per person) <br />ALL OWNED SCHEDULED <br />.... . .. .... .. I .......... ..... <br />AUTOS AUTOS <br />BODILY INJURY (Per a=dem) <br />NON-OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE ... . . ..... <br />_.�Peracc'jdent) ....... . . ......... - ... . ......... <br />.. .... . ... ........ <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAR CLAIMS MADE <br />AGGREGATE <br />RETENTIONS <br />IS <br />WORKERS COMPENSATION <br />PER 1 OTH- <br />AND EMPLOYER$'LIABILITY YIN <br />STAT "I E ER -11 . ...... . . . . ........ <br />ANY P'ROPRIETORIPARTNERIEXECUTIVE <br />OPFiCeRIMEMBER EXCLUDED? WA <br />0 <br />E L. EACH ACCIDENT $ .......... <br />(Mandatory in NH) <br />E .L, DISEASE - EA EMPLOYEE( $ <br />If yes describe under <br />DESCRIPTION OF OPERATIONS nerow <br />E L DISEASE -POLICY LIMI I <br />A Professional <br />11/0112015"11/0112016 Oar Claim 1,000,000 <br />Liability j <br />Aggregate 2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requIred) <br />CLAIMS MADE POLICY - RETROACTIVE DATE: 11/01/1987 <br />Subject to all policy terms, conditions and exclusions. <br />30 days NOC except <br />10 for non-payment of premium. <br />PROVED AS T(') VORM <br />LaUra A. P%Ossilli <br />CERTIFICATE HOLDER rANrF=l I ATInIU IietaE 111W) "Ita" J 1 .7 <br />CITYSAA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />P.O. Box 1988 <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, M-29 <br />Santa Ana,, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />@ 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25,(2014/01) The ACORD name and logo are registered marks of ACO'RD <br />