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ACORM CERTIFICATE OF INSURANCE 996 DATE 5/24/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Barney & Barney, LLC - CA License No. 0003950 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Barney & Barney, Inc. - CA License No. OC24310 POLICIES BELOW. P.O. Box 85638 COMPANIES AFFORDING COVERAGE San Diego, CA 92186 -5638 MST #5 COMPANY A TRAVELERS INDEMNITY CO. OF ILLINOIS LETTER INSURED �, �1[;'�% 1/1�� Y A Jl COMPANY B NO COVERAGE ON THIS DOCUMENT LETTER Berryman &Henigar Enterprises Berryman & Henigar, at al COMPANY C NO COVERAGE ON THIS DOCUMENT LETTER 11590 West Bernardo Court San Diego, CA 92127-1624 COMPANY D NO COVERAGE ON THIS DOCUMENT LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE (MM /DDAY) LIMITS (MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGATE .... $" "2,000,000 ® COMMERCIAL GENERAL LIABILITY 630525D5655 12/31103 12/31/04 PRODUCTS- COMPIOP AGG. $' "...."2,000,000 A ❑ CLAIMS MADE ® OCCUR. PERSONAL & ADV. INJURY $••". ^•`1,O00L000 ® OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE V.. "'° "1,000,000 ❑ FIRE DAMAGE (Any one fire) $ " "" """"""^100,000 MED. EXPENSE (Any one person) $••`••"•`•.`•• »5,000 AUTOMOBILE LIABILITY COMBINED SINGLE ® ANY AUTO 810525D5655 12/31103 12/31/04 LIMIT V.,. "' "`•1,000,000 ❑ ALL OWNED AUTOS BODILY INJURY A ❑ SCHEDULED AUTOS (Per person) $.^ ..................0 ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) $ ............... «..0 ❑ GARAGE LIABILITY PROPERTY DAMAGE $......•.... " "` "`•"0 EXCESS LIABILITY EACH OCCURRENCE $' "' " "'" "'5,000,000 A ® UMBRELLA FORM CUP 525D5655 12/31/03 12/31/04 AGGREGATE $ " "" "'5,000.000 ❑ OTHER THAN UMBRELLA FORM ❑ STATUTORY LIMITS WORKERS' COMPENSATION AND EACH ACCIDENT $•` " " ". ..... ••••0 DISEASE - POLICY LIMIT EMPLOYERS' LIABILITY DISEASE - EACH EMPLOYEE $•• "•^ ••• ^ ^ " ^"•0 OTHER F1010 VEPAGE DESCRIPTION OF OPERATIONS /LOCATIONS VEHICLES /SPECIAL ITEMS '10 days notice Of Cancellation applies to non - payment RE: PAVEMENT MANAGEMENT SERVICES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO City of Santa Ana MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ATTN: JOE PARCO, SR. CIVIL ENGINEER LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 20 CIVIC CENTER PLAZA LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. SANTA ANA, CA 92701 AUTHORIZED REP SENTAJAVE s 6Z*9 ACORD 25 -S (7190) /CORD CORPORA - rHE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER THE ATTtXCHED ENDORSEMENT n IO" _