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<br />T-470 P 02/03 F-547
<br />
<br />From-DRIVER ALLIANT INS, C
<br />1'1 ~
<br />
<br />
<br />'~~~~-""'\""'."'''''I'I
<br />1016/05
<br />
<br />PRODUCIlIl
<br />Driver. Alliant Insurance Services, Inc.
<br />P.O. Sox 25884
<br />Santa Ana, CA 92799
<br />(800) 821-9283 Ex!. 190. Fax (949) 756-2713
<br />LicenY No. OC36861
<br />lNSUReO SPECIAL LWilLltv 1~l,JRANCE PROGAAM (SLIPl ~fiiR
<br />FAMILIES TOGETHER OF ORANGE COUNlY ~;;jOO1-;;ZO I
<br />801 S. LYON ST. ~__"I .
<br />~NTA I'>NA, CA a~705 ~ ,?C<J7 - ..20;J..
<br />A- ;;J.tJD'-!-;).u{- 0/
<br />;dva.oc>4-C).{)~- 0 /
<br />
<br />/hy,f5c")5 -076'-01-1
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOIlMATION ONLY AND
<br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATe
<br />DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED llY THE
<br />POLICIES BELOW,
<br />
<br />COMPANIES AFFORDING COVERAGE
<br />
<br />C"""AI<Y
<br />LETTER
<br />CO...
<br />LETTER
<br />""""ANY
<br />LETTER
<br />QQMpANY
<br />LETTl!ft
<br />CON'AI/V
<br />LETTER
<br />
<br />A EVANSTON INSURANCE COMPANY
<br />
<br />B
<br />
<br />C
<br />
<br />o
<br />
<br />E
<br />
<br />THW IS TO CERTI """'T TH! POUc::lQ; OfIIN$UlU.NCI! UITIi!) IQ.OW HA\It! BEDI INUEO to THe INSURED ~I.D ABove FOR 'fHI POLlCY PERIOD INOICAnc,
<br />NO"rWITHST~G AI('( RIOUIREMENT, l'J!~ 0fC CONDITXlN Of aN( CMMCT OR OTHER CtOCUMEHTWlTH R~~ TO WHQiI T..... ClltTl'tCAT. M4Y AS ISSUfD
<br />OR MA,Y Jl"tiRTAIN. THI.I....LHt.t.NC1 AFFC)R[)EP av nee f"OUCImS DEaC,.aQ klftlllN I8lSUBJI!!CT TO AU. THIE TERMS. EXCL.uSION AND CO~DlTIONS w: SUCH POLleES.
<br />UMtTS W. ISHN 1ItJ!000000g BY PAID clAtMI,
<br />
<br />CO
<br />LTR
<br />
<br />TypE OF INSuRANcE
<br />
<br />,DUCY NUI4Ill!~
<br />
<br />A
<br />
<br />GENERAL I..IA8ILITY
<br />COMMU(CIAL GENERAL
<br />LIABILITY
<br />Cl.A.IMS f""Xl OCC:UR
<br />MACE ~
<br />OWNEFt'S &. CONTRACTORS
<br />PROT.
<br />GI. D1iD:S1.000
<br />
<br />SLIP3000-05
<br />
<br />
<br />A
<br />
<br />AUT""'-" I.lAllIUTY
<br />
<br />SLIP~O!i
<br />
<br />ANY AUTO
<br />ALl. OWNED AUTOS
<br />SCHEOul..SO AUTOS
<br />X HIFU;;D AurOS
<br />X NOkoOwHEO AUTOS
<br />GARA" UA811..JTY
<br />AUTO DeD: $1,000
<br />
<br />PQL)CY efFECTIVE.
<br />DATE (U~MY1,
<br />
<br />PCUCY
<br />BXP'IiATJON
<br />OATE DIYV
<br />09/28106
<br />
<br />N1A
<br />$1,000,000
<br />$1,000,000
<br />$1,000,000
<br />$1,000,000
<br />N1A
<br />$1,000.000
<br />
<br />...-a
<br />
<br />GENERAL AGGRl!GAn
<br />PROOUOTS-cQMPJOp
<br />AG .
<br />PE NAl & ArN_ 1NJUt(
<br />
<br />EACH OCCUf<Al!HCE
<br />
<br />09129/05
<br />
<br />FIRE; DAMAGE (Arly on. hr.)
<br />MiD. ~liiNSe (AO)' 01"16
<br />"""
<br />
<br />09/29106
<br />
<br />eODlLYI",uUflY
<br />(Pcrpcr-..a"l)
<br />BOOtly INJURY
<br />{Plel"i:Il;QclenU
<br />PROPl:RTY J)AMAGE
<br />
<br />APPROVED AS 0 FORM
<br />
<br />
<br />UYBRELlA FORM
<br />OTHER THAN UMBIceLJ.A F'OR.,.
<br />
<br />WORKER's COUPIENSATtON
<br />ANP
<br />BtPI.OY&R'& LIABILITY
<br />
<br />A
<br />
<br />NON-PROFI'r OIRECTORS
<br />AND OFFICERS
<br />PQt;RIhlON OF DJOEIlATI~l..OCATION:sI'IID<<lLEJIIS~1AL IttM$
<br />
<br />SLIP3000.0S
<br />
<br />EACJ1 OCCvAAENCE
<br />AGGREGATE
<br />
<br />'2.~~ ,~~~-'- w.,_"'--~_~ '_ n~
<br />~,\'.,."
<br />
<br />EACH ACCIOENT
<br />D L1CV LIMIT
<br />OlseASE-EACH EIAP,Ovee
<br />
<br />09/29/05
<br />
<br />$1.000.000
<br />
<br />09129106
<br />
<br />P!';R OCCURRENCE AND
<br />ANNUAL AGGREGATE
<br />
<br />AS RESPECTS TO THE COMMUNITY DEvELOPMENT BLOCK GRANT. THE CITY OF SANTA ANA, ITS OFFICERS. AGENTS, EMPLOYEES AND
<br />VOLUNTEERS SHALL BE illAMEO AS ADDITIONAL INSURED, THIS INSuRANCE IS PRIMARY ANO ANY INSuRANCE OR SELF INSURANCE MAIN! AINEO BY
<br />SUCH ADDITIONAL INSUREDS SHAll NOT CONTRIBUTE TO IT. ADllfTlONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POI.ICY TERMS.
<br />CONDITIONS AND ExCI.USIONS.
<br />
<br />I ~r,~ ~0"~-;;-~f~li~~i;':~ ~~:.' ~;Iilli-;J)~~\~{:;:l'~i:~~'.~,n;;:~~~:~ '::' ::t:':;":;,:'i:L'Ji:<,If,~;;
<br />
<br />CITY OF SANTA ANA
<br />COMMUNITY DEVELOPMeNT AGENCY M-~S
<br />~ CIVIC CENTeR DRive
<br />PO 80x 10SS
<br />SANTA ANA.CA Q~702
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<br />EXPlRAnOll-l OATE THEREOF. THE. I$SUING COMPANY W/I..L IlJ'~~ "' ,....q TO MAlL
<br />~O DAYS WRITTEN NOTICe TO THE CERTIfiCATE HOI.DER NAMED TO '!liE "EFT,
<br />BUT FALURE TO MAIL ~UCH NOTtel SHALL IMPo,sE 1'1I0 OOl..lGA TION OR UA!UL-I'1'Y
<br />OFAHY KiND UPON iM. COMPANY. ITS ACfiNTS OR REP~$E;NTATIVES
<br />.E><CE:PT 10 !:IAV$ FOR NON-PAyMENT
<br />AU HORIZED ATIV
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