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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />4- J,OOJ.-03<p-
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<br />4- - .;),003- OYb
<br />If ~_,AD(.)3. - 11;)",
<br />
<br />AmBDm
<br />
<br />PRODUCER
<br />
<br />Dealey, Renton & Associates
<br />P. O. Box 10550
<br />Santa Ana, CA 92711.0550
<br />714427.6810
<br />
<br />INSURED
<br />
<br />RBF Consulting
<br />PO Box 57057
<br />Irvine, CA 92619-7057
<br />
<br />Client#: 6255
<br />
<br />RBFCONSUl
<br />
<br />DATE (MM/OOlYY)
<br />12/02/03
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />, INSURER A:
<br />!-I~SURER--B
<br />i INSURER C
<br />, INSURER 0"
<br />, INSURER E:
<br />
<br />Tra"elersJndemnityCo. ofl!lInois
<br />Hartford Fire Ins. Co.
<br />Fireman's Fund Insurance Co.
<br />underWriters at L1OXd's london
<br />
<br />COVERAGES
<br />
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />INSR -- :POI..ICy-'EFFECTIVi:(
<br />LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/D IVY
<br />
<br />A GENERAL UABI!.!TY PG3050~D409203 111/30/03
<br />
<br />X COMMERCIAL GENERAL LIABILITY I
<br />
<br />CLAIMS MADE X! OCCUR INDP. CONTRACTORS
<br />X CONTRACTUAL INCLUDED.
<br />X BFPD,XCU,OCI'
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />,'-'-1
<br />POLICY I X '~~~ X : LOC
<br />AUTOMOBILE LIABILITY
<br />
<br />B
<br />
<br />: x ANY AUTO
<br />ALL OWNED AUTOS
<br />: SCHEDULED AUTOS
<br />
<br />X HIRED AUTOS
<br />X
<br />
<br />NON-OWNED AUTOS
<br />
<br />GARAGE LIABILITY
<br />ANY AUTO
<br />
<br />C 'EXCESS LIABILITY
<br />X ! OCCUR
<br />
<br />CLAIMS MADE
<br />
<br />DEDUCTIBLE
<br />RETENTION $
<br />wcm;~RS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />
<br />D ,OTHER Professional
<br />Liability
<br />
<br />!POUCY Ex:i:iiRATlbN~
<br />, DATE MMlDDIYY
<br />! ~ 1/30./04
<br />
<br />!57UENTl0126
<br />
<br />! 11130/03
<br />
<br />I
<br />! 11/30/04
<br />
<br />~) I
<br />, ,
<br />~ " .
<br />'''O ...' ",w~~l
<br />, ,', 'I"
<br />
<br />IV
<br />
<br />XSM00097333165
<br />
<br />11/30/03
<br />I
<br />
<br />11/30/04
<br />I
<br />
<br />I PROFESSIONAL
<br />LIABILITY IS
<br />.EXQ~QgQ.,____.
<br />I
<br />
<br />! PI039400
<br />
<br />i
<br />, 11/30/03
<br />i
<br />
<br />11/30/04
<br />
<br />DESCRIPTION OF OPERATIONSlLOCATlONSNEHICLEstEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
<br />General Liability policy excludes claims arising out of the performance of professional
<br />services.
<br />
<br />Re: IN 10.103090, On.call Services
<br />(See Attached Descriptions)
<br />
<br />CERTIFICATE HOLDER
<br />
<br />ADDlTlQNAL INSURED ;INSURER LETTER:
<br />
<br />CANCELLATION
<br />
<br />LIMITS
<br />
<br />EACH OCCURRENCE ,.~1!QoO;.QQ9
<br />! FI~~PAMp,~~..(Anyy~e__firEl) 1~:L9001().Q9
<br />MED EXP (Any?ne perso!l) i $~I'<<:)OO
<br />PERSONAL & ADV INJURY _ r $.1 ,o.Q9.l9()O
<br />~.Q.~NER~_~_"".GG~.E:~~!E___.___: $2A)!tQ,Qoq
<br />l,.~~~Y~!.S__:~O_~l9~ A~9_t,~~,OQ()A)QO
<br />,
<br />
<br />COMBINED SINGLE LIMIT
<br />1 (Eaaccidenl)
<br />r ,-
<br />I BODilY INJURY
<br />(Per person}
<br />I '
<br />BODilY INJURY
<br />(Peraccidenl)
<br />
<br />i $1,000,000
<br />
<br />$
<br />
<br />$
<br />
<br />i PROPERTY DAMAGE
<br />! (Per accident)
<br />
<br />i$
<br />
<br />I A~!9gNl_'r:_~_~A",,~9.!~~N!---J_$_
<br />, OTHER THAN EA ACC _+~_
<br />AUTO ONLY: AGG I $
<br />LE""<::.I:l.2_CC.!:!B~_E.N<::~ __; $10lPOO--,PO(L.
<br />I AGGRE~ATE f.:10,00ll,OOO
<br />$
<br />$
<br />,$
<br />
<br />, we STATU. 'OTH-
<br />iTQAY.lIMI.T$_ ' _I;R
<br />i E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA E.~~LOYEE.$
<br />i E:.L. DISEASE - POLICY LIMIT! $
<br />i $1,000,000 Per Claim
<br />, $2,000,000 Annl Aggr.
<br />
<br />City of Santa Ana
<br />Public Works Agency,Atl: Zed Kekula
<br />20 Civic Center Plaza
<br />Mail Station 43
<br />Santa Ana, CA 92701
<br />
<br />SHOULD ~YOFTHE ABOVE DESCRIBED POLlClfSBE C~CElLED BEFORE THE EXPIRATlON
<br />DATE THEREOF, THE ISSUING INSURER WfLL)CJ(~XJClMAIL30 DAYS WRITTEN
<br />NOTICETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFT, B~XJU~~lIJUllltfGX.)(x
<br />~X~~)(lX:XJlItAarJOJ(kll('J11l.lltDt8(~JlX~J(nGllR:x
<br />:lI'XIUJe6'lXllalH-llX
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />ACORD 25.S (7/97) 1 of 2
<br />
<br />
<br />#M81822
<br />
<br />
<br />II
<br />
<br />@ ACORD CORPORATION 1988
<br />
<br />/14f ~,
<br />
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