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<br />"~c..~D_
<br />
<br />CERTIFICAT~ OF LIABILITY INSUR.
<br />
<br />
<br />DATE IMMlDDIYY)
<br />
<br />ClOP 10 JE
<br />~LVE-6 07/31/01
<br />THIS CERTIFICATE IS I ED AS A MATTER OF INFORMATION
<br />ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
<br />
<br />I , ! r5R~\j~YT51 IU~R.
<br />I
<br />I E.L. EACH ACCIDENT ,
<br /> E.L. DISEASE - EA EMPLOYEE S
<br /> E.L. DISEAse. POLICY LIMIT ,
<br />i 4558167800 10/31/00 10/31/01 , Business $10,000
<br />,
<br />,
<br /> i Protlertv
<br />
<br />PRODUCER
<br />Flagstaff Insurance,
<br />PO Box 1807
<br />2100 E. Cedar Ave.
<br />Flagstaff AZ 86002
<br />Phone: 520-774-6631
<br />INSURED
<br />
<br />Inc.
<br />
<br />Fax:520-779-1765
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />INSURER A
<br />INSURER B
<br />INSURER C
<br />INSURER 0:
<br />INSURER e"
<br />
<br />
<br />Silver Rose Enterprises, LLC
<br />Marsha Rose
<br />1319 W Seascape Dr
<br />Gilbert AZ 85233
<br />
<br />COVERAGES
<br />
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />lr/G TYPE OF INSURANCE I POLICY NUMBER
<br />~NERAL LIABILITY I
<br />A X COMMERCIAL GENE~IABllITY 4 5 5 816 7 80 0
<br />i CLAIMS MADE L!J OCCUR
<br />
<br />&~~~"'jMMlDDNYi - DATE'IMW~{ff~~N
<br />
<br />EACH OCCURRENCE
<br />
<br />10/31/00
<br />
<br />10/31/01
<br />
<br />FIRE DAMAGE (Anyone fire)
<br />
<br />-
<br />-
<br />~'L AGGRE~E lllMIT AP~S PER:
<br />I POLICY I ! ~~T I IlOC
<br />~TOMOBILE LIABILITY
<br />ANY AUTO
<br />
<br />MED EXP (Anyone person)
<br />PERSONAL & ADV INJURY
<br />
<br />-
<br />-
<br />-
<br />-
<br />-
<br />-
<br />
<br />ALL OWNED AUTOS
<br />SCHEDUlEO AUTOS
<br />HIRED AUTOS
<br />NON-OWNED AUTOS
<br />
<br /> GENERAL AGGREGATE
<br /> PROOUCTS . COMPIOP AGG
<br /> ! l COMBINED SINGLE LIMIT
<br /> I
<br /> , (Ea accldenl\
<br /> i
<br /> , i BODILY INJURY
<br /> I ! (Per person)
<br /> BODilY INJURY
<br /> (Per accidenl)
<br />I PROPERTY OAMAGE
<br /> (Per acodenl)
<br />I AUTO ONLY. EA ACCIDENT
<br />I OTHER THAN EA ACC
<br /> AUTO ONLY AGG
<br /> I EACH OCCURRENCE
<br /> AGGREGATE
<br /> ,
<br /> I
<br /> ,
<br />
<br />,
<br />I
<br />~~GE LIABILITY I
<br />I ANY AUTO i
<br />
<br />EXCESS LIABILITY !
<br />=:J OCCUR D CLAIMS MADE I
<br />
<br />I DEDUCTIBLE I
<br />I RETENTION S I
<br />
<br />I WORKER:::. COMPH~SATICN AND
<br />EMPLOYERS' LIABILITY
<br />
<br />OTHER
<br />
<br />A Property Section
<br />
<br />LIMITS
<br />
<br />, 1000000
<br />, 50000
<br />, 5000
<br />, 1000000
<br />, 1000000
<br />, 1000000
<br />
<br />,
<br />I
<br />
<br />I'
<br />
<br />,
<br />
<br />,
<br />
<br />,
<br />,
<br />,
<br />,
<br />,
<br />,
<br />,
<br />,
<br />
<br />DESCRIPTION OF OPERATlON$1LOCATlONSlVEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS
<br />City of Santa Ana, its officers, agents, and employees are n~ed additional
<br />insureds with respect to all operations by the named insured. . 10 day AP~VED AS TO FOB}/
<br />notice of cancellation will be sent for no-payment of premium. -~~ I ~y~
<br />
<br />C ISTINE L.EE SHAW
<br />CERTIFICATE HOLDER l'l i ADDITIONAL INSURED, 'NSURER LETTER, CANCELLATION DeputY ~IlY ,,,,,..' , '1 "
<br />
<br />SANTAAN
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRATID
<br />DATE THEREOF, THE ISSUING INSURER WILL.. MAIL ~ DAYS WRITTEN
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />
<br />City of Santa Ana
<br />100 S. Santa Ana Blvd Ste 200
<br />Santa Ana CA 92701
<br />
<br />
<br />
<br />ACORD 25-S (7/97) @ACORD CORPORATION 1988
<br />
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