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<br />. <br /> <br />ffWJ1~~ !t-;)O{)3-lli <br /> <br />~- <br /> <br /> C;::ERTlFICA TJ;: OF INSURANCE <br /> This certificate is furnished to you as a matter of information only. This is not an insurance policy. and the issue arlhis certificate does not amend or alter the <br /> coverage afforded by the policies listed on the certificate. Notwithstanding any requirement. tenn or condition of any contract or other document with respect <br /> to which this certificate is issued, the insurance afforded by the policies listed on this certificate is subject to all tenns of such policies. <br /> This certificate cancels and supersedes any and all prior certificates issued on behalf orlhe named insured to the certificate holder designated below. <br /> CERTIFICATE City of Santa Ana ISSUI~G HP CO. Judy Parks, MS 5578 <br /> HOLDER AND 20 Civic Center Plaza ADDRESS AND Hewlett-Packard Company <br /> ADDRESS, Santa Ana, CA 92702 CONTACT 8000 Foothills Blvd. <br /> PERSON, Roseville, CA 95747-5578 <br /> LOCATION OF Ilsame as the Certificate Holder II TELEPHONE: 111916-785-3860 I <br /> RISK: <br />I I Policy Policy <br /> Coverage Company & Policy Number ElTectiveDate Expintion Date Limit or Liability <br /> (mmlddlyyyy) (mm/ddlyyyy) <br /> WORKERS' COMPENSA TIONI Old Republic fnsurance Co. 9/3012004 913012005 Statutory Workers' Compensation <br /> EMPLOYERS' LIABILITI' INCI-: MWCI I 1077 00 Limits <br /> ll. All States Coverage <br /> b. U.S. Longshoremen & Harbor All states except CA, WA. CO, Employers' Liability - see below <br /> Workers and OR I Each Accident 11$1.000,000 I <br /> c.Maritime <br /> Work Comp excludes WY, WV, <br /> OH, and NO Disease-Each 1$1.000,000 I <br /> Employee <br /> Disease - Policy I SI,ooo,Ooo I <br /> Limit <br /> COMPREHENSIVE GENERAL Old Republic Insurance Co. 9/3012004 913012005 Bodily InjurylPropeny Damage <br /> LIABILITY, INCI- PERSONAL Combined Single Limit <br /> INJURY & PROPERTY DAMAGE MWZY 56574 $2,500,000 Per Occurrence <br /> INCI-: ~, ~/b <br /> a. Premises/Operations rfa" <br /> b. Independent Contractor <br /> c. Contractual Liability C <br /> d, Completed OperationsIProducts <br /> e. Explosion. Underground &. Collapse <br /> (XCU coverage) <br /> AUTOMOBILE COVERAGE Old Republic Insurance CO. DD Bodily InjurylProperty Damage <br /> a. OYlRed Vehicles Combined Single Limit <br /> b. Leased Vehicles $2,500,000 Per Accident <br /> c. Hired Vehicles MWTB 19039 <br /> d. NOD-owned Vehicles <br />I F.xCF.SS LIABILITY I T,II Tn,,, In,".an" CO, EJEJ $500,000 Combined Single Limit <br /> Excess of$2,500,000 SIR or <br /> 47o.1Xl.OO12 Underlying Policies <br /> NOTES: <br /> The City of Santa Ana, its officers, Addltloaal <br /> and its employees are named as Additional Insured <br /> Insureds for General Liability coverage as per written contract. P" <br /> Nou.: In the event of cancellation olthe above described policy, the issuing company will endeavor to give 30 days p,io, w,itten notice to the cenlflcote <br /> holde,. <br /> NAMED INSURED A. ~D ADDRESS: AUTHORIZ~EPRESENT A TlVE: <br /> m HEWLETT __ I L...J!7. ../ - <br /> PACKARD 1;}i12~ -- ~ <br /> HEWLETI.PACKARD CO. Date Issued: <br /> 3000 HANOVER STREET Marsh Risk and Insurance Servkes. Inc. <br /> PALO At TO. CA 94304 777 S. Figueroa. Los Angeles, Ca. 90017 Phone: (213) 346-5096 <br />