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<br />Marsh, Inc,
<br />
<br />5/9/2005 11:21 AM
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<br />Fax Server
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<br />PAGE
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<br />2/002
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<br />PRODUCER
<br />Marsh
<br />3475 Piedmont Road N.E., Ste 1200
<br />Atlanta, GA 30305
<br />
<br />CERTIFICATE NUMBER
<br />A TL..IJOQ7911 63-20
<br />THIS CERTFlCATE: IS ISSUED AS A.~'ATTER OF INFORMATION ONLY AHD CONFERS
<br />NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
<br />POLICY. nus c.ERTFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
<br />PfFORDED BY TItE POLICES DESCRIBED HEREIH_
<br />
<br />Attn: Brenda Young-Epps
<br />
<br />COMPANIES AFFORDING COVERAGE
<br />
<br />(404)995-3074
<br />
<br />CCl'<P A'N
<br />
<br />75142-CAS-
<br />
<br />A
<br />
<br />FEDERAL INSURANCE CO
<br />
<br />INSURED
<br />
<br />CaW'A'N
<br />B AMERICAN INTL SOUTH INS. CO
<br />
<br />Scantron Corporation
<br />34 Parker
<br />Irvine, CA 92618
<br />
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<br />
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<br />
<br />CQ\l"PNY
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<br />'~M!~_il~zmi1iiift.~@itl1~fi~l:m~~-;r~~ti_ii~l "~<#.<",~i;%\-'--0o!/'x'--'"'~~~~":~~l1illl:.r;;J$:~'%!tt.Stl,triStz
<br />
<br />1':"'15 IS TO CERTIFY THAT PO..lOES 0:= INSURA.'IICE DESCRIBS) HER::IN HAVE BEeN ISSU~ TO THE INSJRED NIWEO l-iEREIN FOR THE PO-ICf PE~IOO 1).J:>ICAl::')
<br />N~Tl-'srA.\lDING ANY REqUIREMENT. TER.'o1 OR CONDITlCN OF my CONTRACT OR OTHER DOOJMENTWlTH RES'ECTTO~\rHICH THE CERllFICATE MAv 80: iss...;o:O OR 'JAY
<br />~RTAlN, THO: IN9J,'i!ANCE AFFORDED BY THE POLlOES ClESCRIBED HEREIN ISSlJBJECT TO M..:" THE TERMS, CONDITIO\IS ^\lD EXo..USONS OF SUCH POlIOES "~REGATE
<br />LIMITS g.;0~ MAY HAVE BEEN REDUCED BY P/1lD O-AlMS
<br />
<br /> co lYPE OF INSURANCE POLlGVNUIlElER POLICY EFFECTIVE POLICY EXPIRATION LiMns
<br /> LTR DATE (NMIDDIYY) DATE tMMIDDtYVj
<br /> i
<br /> A GENERAL LIABILITY 135381324 103/01/05 03101/06 G:NERAL AG~EGATE $
<br /> ~~~~I'.1ERaPL GE';NERAL LIABiliTY PRODUCTS. CCMP!OP AGG $
<br /> bmj : QAlMS,'vIKJE [K] OCruR i I PE:;;roNti. & AnV ,,\I.l':;:<v $
<br /> J ONNER.S&CC><TRACTOR.SPROT I I EA01 OCCURRENCE $
<br /> I
<br /> X !PR!NTFR~ FR.O , $
<br /> I FIRE DJ\'tlAGE (Any C<"Ie~reJ
<br /> i I MED EXP An rn9~!J'&n) $
<br /> A I AllTO.1OBILE L1ABIUT'( 73260213 (ADS) 03/01/05 03101/06 CO'I'BI,\;EQ SNGl;;:: L1M'T $
<br /> A R ~v ~TO 73260209 (TX) 03101/05 03101106
<br /> A JILL Ov'INEO AUTOS 73260210 (VA) 03/01105 03101106 BOOIL y IN~URY $
<br /> A a "'HEDULED AJTOS 73501034 (MA) 03/01/05 03/01106 ("erwOOl)
<br /> A HiREOPJ.JTOS 73260212 (PR) 03/01/05 03101/06 BODilY INJU'<:V
<br /> i r.,a.;.O\NNED AUTOS i\,<:; ,r, (::>era.xidclnl) $
<br /> F RM
<br /> ~ OMPREHENSIVE - $1 ,000 FROPERTY 0,.,...,A8E $
<br /> X ~OLLlSION -$1,000 Oed
<br /> RAG' LIABILITY ~TOONLY .EAACOD?NT $
<br /> "NY!UTO or,,;::R THAN M.;TO ON. Y
<br /> U',. '\i lilr:1CY $
<br /> EAC.., AceD!::" T
<br /> ,--
<br /> , , $
<br /> . I AGGR::GATE
<br />" B EXCESS LlABILllY iBE298831 B 103/01105 $
<br /> 03/01106 EAC-, OCOiR.:;:ENCE
<br /> X : ".Ji\IBi'ELLA=CRM I AGGREGATE $
<br /> : OTHE,:;; r"AN IJMa.'i:EL'-A f'OR'o1 I $
<br /> A i WORKERS COMPENSATION ANO 135381324 103101/05 03101/06 OT"
<br /> : EMPLOYERS'LIABILlTY EO
<br /> I
<br /> i
<br /> , T..,E PRO;;:RIETORI i $
<br /> PAi'<TNERSoF.XEc.JTIVE R'''~ I EL DISEASE-Po..:cy LI'u1IT
<br /> CFF:c::!3iSA!'<t' i 8<0..1 EL DISEASE-2..I(;1-l EMF'_OV=E $
<br />
<br />
<br />
<br />2,000,000
<br />2,000,000
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />10,000
<br />1,000,000
<br />
<br />5,000,000
<br />5,000,000
<br />
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />
<br />OESCRIF'TION OF OPERATIONSILOCAllONSIVEHICLESlSPEClolIl.lTE.1S
<br />The City of Santa Ana, its officers, employees, agents, and representative are induded as additional insured as their interest may appear per written contract.
<br />
<br />
<br />9-IOl.li) I1.NV OF l'e POLICES DESC;tIEl"ED i-'EREIN !IE CANCEOLLIOU !li':m;t.'" T/-E EX?' ~~.TON [JoT:' THE~ErF,
<br />THE IN.<ul.ER "'F~C1;DING C()>JE_~"'a::: '.'011.1.- E~ ......'L ----3..0. ClAYS ',\'!<TT:'N NeTCE TO nE
<br />
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />P,O. Box 1988
<br />Santa Ana, CA 92702
<br />
<br />ISSUE,~ OFTl-1ISCERTIF'CIon:
<br />
<br />CE'l.TlF;CATE HO...:JER N',t.EIlI-EREIN. BUT FAILU'lE TO M"IL SUCH NOTICE SH"L'_ tt.PD:oE NO C~.;G'oTiCt-l G<
<br />
<br />L1AaILrTYOF ANV,INQ UFONTHE IHSJ'l.ER AFFOFlUlNG CC/Ji':;:tAGE, ITS"'.Gi':NTSO~ RE~R=s;orn~_~""'s OR 11-'1"
<br />
<br />r.lARSH USA INC.
<br />BY: Mid1ael Dennis
<br />
<br />ft4J #-
<br />
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