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To: City of Septa Ana <br />From: Blanca Roque <br />Blanca Roque <br />Wood -Gutmann & Bogart/IIIB <br />910 S. EI Camino Real, Ste B. <br />San Clemente CA 92672 <br />(949) 542-7800 <br />www.integrityint.com <br />A-2005-223 <br />Fieldman, Rolapp & Associates <br />19900 MacArthur Blvd, #1100 <br />Irvine CA 92612 <br />5-18-07 2:59pm p. 2 of 7 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURER Hartford Casualty Insurance Company <br />A <br />INSURER Oak River Insurance Company <br />B <br />INSURER <br />C <br />INSURER <br />D <br />INSURER <br />i cv t$tLUW HAVE BEEN ISSUED TO THE INSUREDiiiil NAUp <br />MED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH 'RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NSR POLICY POLICY <br />LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION <br />GENERAL LIABILITY DATE DATE <br />A COMMERCIAL GENERAL LIAB 72SBAAF9892 LIMITS <br />4/1 /2007 4/1/2008 EACH OCCURRENCE $ <br />CLAIMS MADE OCCUR FIRE DAMAGE An one fire $ <br />MED EXP (Any one ne-i e <br />Au I UMOBILE LIABILITY <br />A <br />u -UP AUU <br />$ <br />ANY AUTO <br />72UECTQ4293$ <br />ALL OWNED AUTOS <br />4/1/2007 <br />4/1/2008 <br />COMBINED SINGLE LIMIT <br />SCHEDULED AUTOS <br />BODILY INJURY <br />$ 1 <br />HIRED AUTOS <br />(Per person) <br />NON -OWNED AUTOS <br />BODILY INJURY <br />$ <br />(Per accident) <br />GARAGE LIABILITY <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />ANY AUTO <br />$ <br />AUTO ONLY - EA ACCIDENT <br />$ <br />A E CESS LIABILITY <br />OTHER THAN EA AC $ <br />AUTO ONLY: <br />OCCUR 1:1CLAIMS MADE <br />72SBAAF9892 <br />AGG $ <br />4/1 /2007 <br />4/1/2008 <br />EACH OCCURRENCE <br />$ <br />DEDUCTIBLE <br />AGGREGATE <br />$ <br />RETENTION $ <br />$ <br />WORKERS' COMPENSATION & <br />B <br />$ <br />EMPLOYERS' LIABILITY <br />22000505190714/1/2007 <br />/2007 <br />4/1/2008 <br />STATUTORY LIMIT <br />THE <br />EA <br />PO <br />of Santa Ana is named as additional insured per attached SS 00 08 04 05 + <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 'BE CANCELLED BEFORE THE <br />Attn: City Clerk E30RA; ION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />______DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br />LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION <br />20 Civic Center Plaza OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- <br />Santa Ana SENTATIVES. ' 10 Days for Non -Payment of Premium <br />CA 92702 AUTHORIZED <br />REPRESENTATIVE <br />Dan Gorman ��'/' <br />