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<br />SEP-30-2~04 THU 11:43 AM <br /> <br />FAX NO. <br /> <br />,< <br /> <br />SANJOAQ-02 <br /> <br />P. 02 <br /> <br />ACORDnø CERTIFICATE OF LIABILITY INSURANCE CATE (MMlDDl't'Y'NI <br /> 9/24/2004 <br />PiiõõüJER (559) 432-0222 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />DiBuduo & DeFendis Insurance Brokers, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />License #OE02096 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />P.O. Sox 6479 <br />Frosno, CA 93755-6479 INSURERS AFFORDING COVERAGE HAlC# <br /> S.n Joaquilï-Chemicals Inc. .......... INSU~R -;:: Arne rican..!!!ternationaiSpeCialty ~i nes "...'-. <br />INSUReD <br /> 4684 East Hedgc$ Ave INsuAeA,~:,~ommerçe & In~~n9u"'nce Compan -...,-- <br /> ""'''"',,.-.. <br /> Fresno, CA 93703-0000 ,!NSURER c: State Compens!tion Insurance Fund,- <br /> ¡J - dCQ3 -D f4 INSURER 0: '''''- ",.... I ',. <br /> INSu~E~ E: I <br /> <br />AYDA <br /> <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED 8EI-OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENi, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ReSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORCEC BY Tl'te POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POL.ICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED ßY PAID CLAIMS. <br />" ,', POUCY NUMBER POuCY EFFECTIVE POUCY EXf'IRAnì?~ <br /> <br /> <br />UMmi <br /> <br />A <br /> <br />GEf\I¡¡RAL LIA8 L 'rr <br />X COMMERCIAL GeNERAL LIA81LITY EG195770e <br /> <br />CLAJMS !MDt:. [!] OCOu~ <br /> <br />p ~ tea occurence) , $ <br />. MED EX!' (Any ¡;me P8rSO,nJ;-- s <br />PERSONAl. /I ADV INJURY $ <br />GENERAL''';GGReGA~E. Is'" <br />PROOUÇ!.~ - COMf'IOP AGG $ '- <br /> <br />EAC o OCCURRENCe -... <br /> <br />4130/2004 <br /> <br />4130/2005 <br /> <br />.---J <br />GEN'L AGGREGATE LIMIT APPLIes PER~ <br />PR . LOC <br /> <br />B <br /> <br /> <br />4130/2005 <br /> <br />COMBINEO SINGLE LIMIT <br />(Ea aCd ~ent) <br /> <br />CA50S3817 <br /> <br />ANY AUTO <br />ALL OWNEiC AUTOS <br />SCHeOUlED Auras <br /> <br />4130/2004 <br /> <br />800lL Y INJURY <br />(Per person) <br /> <br />HIRED AUTOS <br />NON-OWNED AUTOS <br /> <br />80CIl Y Il\IJuAY <br />(Per accident) <br /> <br /> <br />1/1 <br /> <br />PROPeAYy DAMAGE <br />(Per acci~eoL) <br /> <br />GARAG¡¡ LIABILITY <br />ANY AUTO <br /> <br />AUTO ONL !: EA ACCIDENT $ <br /> <br />OTHER THAN ~ ACe $ <br />AUTO ONLY: AGG S <br /> <br />A <br /> <br />D:C¡¡SSlUMIlREI-L4 LtAIIlLlTY <br />OCCUR 0 eLAJMS MAce EGU1957709 <br /> <br />4/30/2005 <br /> <br />EACH q,~CURRI>NCE <br />AGGRI>GATE <br /> <br />4130/2004 <br /> <br />C <br /> <br />OEOUCilBLe <br />X ReYENnON S 10,000 N <br /> <br />WORKERS COMPE/IItATION ANO <br />EMPLOYüS' LIABILITY <br />ANY PFlOPRIETORIPAFtTNERlEXECUTlVe <br />OFflCERlMEMIIEA ExcluOfi'O? <br />If }lA, IIsscrloe under <br />SPECIAL P~OVISJON8 DetOlO' <br />OntEiR <br /> <br />6/29/2005 <br /> <br />WC STATU. <br />I <br />e.l, EACH ACCIDENT $ <br />E.L:'PlseASe - EA EMP~OYEJ $ <br />E,l, OISEASE. ~LICY LIMIT I $ "' <br /> <br /> <br />168187504 <br /> <br />8/29/2004 <br /> <br />$ <br /> <br /> <br />$ <br /> <br />$ <br /> <br />$ <br /> <br />$ <br />S <br />$ <br />$ <br />$ <br /> <br /> <br />DesCRIPTION OF OPeRATIONS J LOCATIOHS I VEHIClQ I EXCLUSIONS ADOSD 8'1' EiNDOaSEMENT I SPECIAL f'R0VIS1ONS <br />City of Santa Ana, its officers, employees, agents, voluntoers and resprtlsentatives are named as Additionallneurad. Such insurance <br />as is afforded by this policy is primaty and is not additional to or contributing with any other insurance carried by Or for the benefit of <br />the additional insured. <br /> <br />CERTIFICATE HOLDER <br /> <br />City of Santa Ana <br />Building Maintenance Division <br />20 Civic Center Plaza #M-11 <br />Santa Ana, CA 927'02- <br /> <br />CANCELLATION <br /> <br />9MOIJLCI ANY OF 'f}¡E ABOVE CESCRiBED POLlCI¡¡s liE CAN<:ELLEC BEFORe THE EiXPIAATION <br />PATE YHEREOF. THe ISSUING INSUR ;R WILL ENDEAVOR TO MAIL 3~ DAYS W~N <br />NOTICE TO THE CI'ImFICATE HOLDER NAMED TO THe: I-£FT, ElllT FAILURe to DO:;O $HALL <br />IMPOSE NO oeLlGAnoN Of! LIA8/Llrf OF ANY I<IND UPON TH ; INSURER. ITS AGE/llTS OR <br />REPRE$E/llTA'I1V¡¡s. <br />AUTHOIIIIZEO REPRESElfTATlVE <br /> <br />~ <br /> <br />~~. <br /> <br />