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I ACORQ. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlYVYy) 01/01/2004 PRODUCER (310) 393-9477 FAX (310) 393-7186 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION White & Company Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POBox 70 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Monica, CA 90406-0070 Cecil Quinones INSURERS AFFORDING COVERAGE NAJC# INSURED Pacifi.c Coast Cabling Inc. INSURER A; Hartford Casualty Insurance Co 29424 9340 Eton Ave INSURER B: Majestic Insurance Chatsworth, CA 91311 INSURER C: INSURER 0: INSURER E; THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DO' TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE PR~!fJ EXPIRATION LIMITS GENERAL LIABILITY 72UUNUQ7399 01/01/2004 01/01/2005 EACH OCCURRENCE $ 1 000 000 ~ COMMERCIAL GENERAL UABIUTY DAMAGE TO RENTED $ 300 OOC I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 10 OOC A I- PERSONAL & ADV INJURY $ 1 000 OOC GENERAL AGGREGATE $ 1 000 00 f= PRODUCTS-COMPKlPAGG 001 rl'l AGGREGATE LIMIT APPUES PER: $ 1 000 ,[Xl PRO- n POUCY X JECT LOG ~TOUOEULE UABJLITY 72UUNUQ7399 01/01/2004 01/01/2005 COMBINED SINGLE LIMIT (Eaaccldent) $ 1 000 OOC ~ ANY AUTO _ ALL OWNED AUTOS BODILY INJURY $ ----=- SCHEDULED AUTOS (Per person) A ~ HIRED AUTOS BODILY INJURY (Peraccldenl) $ ..! NON-OWNED AUTOS - PROPERTY DAMAGE $ (Peraccldenl) RAGE UABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ ~ESSIUM8RELLA LIABILITY 72RHUUQ7263 01/01/2004 01/01/2005 EACH OCCURRENCE $ 6 000 ooc X OCCUR 0 CLAIMS MADE AGGREGATE $ 6 000 OOC A $ R ,OEDUCT'BLE $ RETENTION $ $ WORKERS COMPENSAT1OH AND C20030290701 01/01/2004 01/01/2005 X I WC STATU- IDJ~' EMPLOYERS'LlABlLITY 1 000 OOC B ANY PROPRIETORlPARTNERlEXECUTlVE E.L EACH ACCIDENT $ OfFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPlOYE $ 1 000 ooc g~~I~~~Y~~NS below E.L. DISEASE - POLICY LIMIT $ 1 000 OOC OTHER DESCRIPllON OF OPERATIONS { LOCATIONS I VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT J SPEctAL PROVISIONS ertificate holder is an additional insured as per form HGOOOl1001, Section II, paragraph 6, attached o the general liability policy and accompanyinq this certi~icate. Except ~or 10 days written notice of cancellation for non-payment o~ premium. I I I I I I I I I I I I I I I I City of Santa Ana, Its Officers, Agents , Employe.. Information Svcs Div ~12 P.O. Box 1966 Santa Ana, CA 92702 SHOULD ~Y OF THe: ABOVE DESCRIBED POLICIES BE CANCelLED BEFORE THE EXPIRATJON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL ~ DAYS WRITTEN NOTCE TO THE CERTFICATE HOlDER NAMED TO THE LEFT, BUT FAA.URE TO MAIL SUCH NOncE SHAll IMPOSE NO OBLIGATION OR UABUTY OF ANY KlHD UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUlHORlZED REPRESENTATIVE Kathleen Benner ACSR KJB I ACORD 2S (2001108) CACORDCORPORATIDN1~ I