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<br />From: Je!:;'S;c.-1 Chavez-Roy At: Bolton & Co. FaxlD: Bolton and Company To: CITY OF SANTA ANA <br />, <br />.- <br /> <br />Date: 2,.1712005 03:24 PM Page: 1 of 3 <br /> <br />. <br /> <br />, ACORD. CERTIFICATE OF LIABILITY INSURANCE DA'J'! (MMIDOIVYVY) <br /> OP 10 J~ 02/17/05 <br /> ADVAN-6 <br />PRODUCIOR 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 ALlER THE COVERAGE AFFORDED BY THE POUCIES BELOW. <br />Pasadena CA91101 <br />~hone:626-799-7000 Fax: 626-441-3233 INSURERS AFFOROING COVERAGE NAIC# <br />INSUREIJ INSURER A: "_t;porl; In.uranl:!i Co:r;po~tion <br /> INSURER B: Fireman's Fund Insurance 21873 <br /> Advanced Automated Systems Ine INSURI;R C: Fearless Insurance Company <br /> 23691 Via Del Ri~ INSURER D: stII.t. CalIpGnoation InD. Fund 35076 <br /> Yorba Linda CA 9 887 <br /> . INSURER 1;: <br /> <br />COVERAGES <br /> <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1HE POUCY PERIOD lfoDICATED. NOTWITHSTANDING <br /> ANY REQUlkEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUt.tENTWJTH RESPECT TO WHICH THIS CERTIFICATE MAY 910 ISSUED OR <br /> MAY PERTAIN, 'rHE INSURANCE AFFORDED BVTHE 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 />LT' N5R TYPE OF INSURANCE POUCY NUMBER I D~TE'iAfr:1nf5tW\c 1r-~.t~1'(~ffir,yy;N LIMITS <br /> ~NERAL LIABILITY ! EACH OCCURRENCl: $1,000 000 <br />A X ~ ==r~ERCIAL GENERAL UABILITY WCP117003565200 01/18/051 01/18/06 PREMISES Ell occurence\ , 100,000 <br /> f-- CLAlMS MADE [!] OCCUR MED EXP (Anyone plll'GDn) $10,000 <br /> ~. $1,000 l'D Ded I F'ERSONAL &ADV INJURY $1,000_,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GIOH'LAGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $2 000,000 <br /> h POLICY 5Cl ff8r n LOC I <br /> ~TOUOBlLE UABILITY 11/13/04 I COMBINED SINGLE liMIT $1,000,000 <br />C ~ Am AUTO BA9891367 11/13/05 (Esaccldent) <br /> - ALL OWNED AUTOS APPROVED AS r BODILY INJURY <br /> , (Perll"lIlSon) $ <br /> - SCHEDULED AUTOS FORM <br /> HIRED AUTOS BODILY INJURY <br /> - $ <br /> NON.oWNEO AUTOS ~L.P d, ~/_~ (Peracc:ldent) <br /> - <br /> - PROPERTY DAMAGE , <br /> ' Lura Stitt('Sh Ip~ (Per Bcclden!) <br /> GARAGE UABIUTY t-\-SSI 'tant City At orne\' AUTO Otl...Y. EAACCIDENT $ <br /> =l ANY AUTO OTHER THAN EAACC $ <br /> AUTO ONl.. Y: AG. $ <br /> ~SSJUMBRELLA UABILITY EACH OCCURRENCE $2 000,000 <br />B X OCCUR D ClAIMS MADE XSMll6680410 01/18/05 01/18/06 AGGReGATE $2 000,000 <br /> $ <br /> ~ ,DEDUCTIBLE .I $ <br /> X RETENTION $0 $ <br /> WORKERS COMPENSATION AND I X IToR'v"'lI'MJTS IUS\' <br />D EMPLOYERS' UABIUTY 713886405 11/13/04 11/13/05 E.L. EACH ACCIDENT $1,000,000 <br />IANYPROP~ETO~ARTNE~ECUTIVE <br /> oFFICERlMEMBER EXCLUDED? E.L: DISEASE M EA EMPLOYEE $1 000,000 <br /> , ~~~~~~'OV;~NSbelow I E.L DISEASE. POLICY LlMrr $ 1 000 000 <br /> lomE. , <br /> I <br />DESCRIPTION OF OPERATIONS' LOCATJONS I VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />GL Additional insured per CG2009 10/93. Primary Wording per the attached. <br />JOb:Operations of the Named Insured <br />*10 day notice for non payment.@ <br /> <br />CERTIFICATE HOLDER <br /> <br />Ci ty of Santa Ana <br />Office of the City Attorney <br />20 Civic Center Plaza <br />F.O Box 1988 <br />Santa Ana CA 92702 <br /> <br />SANTAA3 <br />,- <br /> <br />CANCELLATION <br />SHDULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATlO <br />DATETHEREOF,THEI5SUINGINSURERWlLL - MAIL. 30* DAVSWRITTEN <br />NOTICE 70 nt!; CERTlFICATri HOLDER NAMED TO THE LeFT, <br /> <br />ACORD 25 (2001108) <br /> <br /> <br />@ACORDCORPORATION198 <br /> <br />-~_._----._--------_..._------._----~----------_._----~------ <br />