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<br />ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID J~ DATE (MM/DDIYYYY) <br />ADVAN-6 05/19/04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Bolton & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />CA License #0008309 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />245 S. Los Robles Ave, Ste 105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Pasadena CA 91101 <br />Phone: 626-799-7000 Fax: 626-441-3233 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Westport Insurance Corporation <br /> INSURER B: Fireman's Fund Insurance 21873 <br /> Advanced Automated Systems Inc INSURER C: Peerless Insurance Company <br /> 23691 Via Del Rio INSURER 0: State Compensation Ins. Fund 35076 <br /> Yorba Linda CA 92887 <br /> INSURER E: <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 />LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MMJDDNYl P8kre'IMMIDDNY N LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> f.- <br />A X ~ COMMERCIAL GENERAL LIABILITY RP1017641 01/18/04 01/18/05 ~~~:S'Es rEa occurence) $ 100,000 <br /> e-- =:J CU\!MS MADE ~ OCCUR MED EXP (Anyone person) $10,000 <br /> ~ $1,000 PD Ded PERSONAL & ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> e-- <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> II ,[Xl PRO- n <br /> POLICY X JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> f.- <br />C ~ ANY AUTO BA9769078 09/15/03 09/15/04 (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br /> - <br /> HIRED AUTOS BODILY INJURY <br /> - $ <br /> NON-OWNED AUTOS ~;~,~ (Per accident) <br /> - <br /> - C/-_ '/Ll~, /~ PROPERTY DAMAGE $ <br /> /)/ (Per accident) <br /> GARAGE LIABILITY '-----' / /// AUTO ONLY - EA ACCIDENT $ <br /> =1 ANY AUTO ,(/ OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000 <br />B ~ OCCUR D CLAIMS MADE XSMOO076293380 01/18/04 01/18/05 AGGREGATE $ 2,000,000 <br /> $ <br /> ~ DEDUCTIBLE $ <br /> X RETENTION $0 $ <br /> WORKERS COMPENSATION AND X I TORY LIMITS I IOJr' <br /> ER <br />D EMPLOYERS' LIABILITY 713886404 11/13/03 11/13/04 $ 1,000,000 <br />ANY PROPRIETORlPARTNER/EXECUTIVE E.L. EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br /> g~EMtS~W'~~s~6~s below E.L. DISEASE - POLICY LIMIT $1,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />The city of santa Ana and Siemens Building Technologies, Inc.,their <br />officers,employees,agents,volunteers and representatives are included as A/I <br />per form CG 2009 (7/96) attached. Primary wording per the attached. <br />Job: City of Santa Ana HVAC Building service agreement. <br />*10 Notice for non payment @ <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />SANTAA1 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WIL' . MAIL 30* DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF I <br /> <br />City of Santa Ana <br />Attn:Clerk of the City Council <br />20 Civic Center Plaza (M-30) <br />P.O Box 1988 <br />Santa Ana CA 92702 <br /> <br /> <br />- - <br /> <br />ACORD 25 (2001/08) <br /> <br />@ ACORD CORPORATION 198 <br /> <br />fllticr <br />