|
<br /><
<br />
<br />ACORD,. CERTIFIC
<br />
<br />PRODUCE' COLONIJIL S0111'H BAY INSURANCE
<br />11659 INGLEWOOD AVENUE
<br />
<br />E OF LIABILITY INSUaNCE
<br />
<br />BROKERS
<br />
<br />DATE(MMIDDI'Y'Y)
<br />9/14/2004
<br />
<br />THIS CERllFICATE 1& ISSUED AS A MATTER OF INFORMATION
<br />ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERnFICATE DOES NOT AMEND. EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
<br />
<br />llAWTHORNE
<br />(310) 973-6591
<br />
<br />CA 90250
<br />
<br />236 WEST MOUNTAIN STREET
<br />?ASADEN
<br />COVERAOES
<br />
<br />A-~-lv\\
<br />#105
<br />
<br />IN&UR,ER .~:.
<br />11'Il6URER 9;
<br />--........
<br />lNSIJRERC.
<br />IN&URE.R: D:
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />GRAN-I Tf 51'ATE INSURANCE COMPANy
<br />STATE NATIoNAL INSURANCE'COM?!\NY
<br />TUDOR INSURANCE COMPANY
<br />
<br />INlURi.D
<br />LIEN ON ME, INC.
<br />
<br />CA 911 09
<br />
<br />INSURER E:
<br />
<br />THE POL.ICIE:S OF INSURANCE LISTED DEL-OW HAVE BEEN IssuED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR oTtlER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE: ISSUED OR
<br />MAY PERTAiN, THE INSURANCE AFFORDED BY THE POLIciES DESCRIBEO HEREIN IS SUBJECT TO ALL lHE TERMS, EXCLUSIONS 1'-NO CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE L.IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />
<br />IN= TYPE (6 ~URANCE .~ .... POlIC"f NUMBER .~.,,~ ~.f=&i~~- '~~~N . ~
<br />
<br />~NEIitAL LIABIliTY' ~ OCCURRENCE
<br />
<br />~ ~~RCIALGENERAl.LIA8lLITY ~~_E.v'I'lYOMflr.)
<br />
<br />I ClJl,NSMAOE 0 OCCUR: PJEOEXP(Anyo.~~rtonl
<br />
<br />BOP-00001702711-01 e/15/Z004 6/15/2005 ""..oow..""",....'""V
<br />
<br />GE_~l AGGAE~~ ~~ ~U~~ PER'
<br />x: I POLICY I I JECr I I LOC
<br />~TOMOIJlLI! UdlUTY
<br />_ f/tN'(AUTO
<br />_ AlL OWNED AUTOS
<br />A _ 6CHEDULEO ,AUTOS
<br />HIRED AUTOS
<br />~ NONoOWNtO AUTOS
<br />
<br />---..--
<br />
<br />GENERAL AOOREGATE
<br />n.'_
<br />r,!-~T5"COMPIO~~
<br />
<br />LIMITS
<br />, 2,000,000
<br />----. -c~
<br />, 100,000
<br />,..,,-----c~
<br />, 10,00.0
<br />s -. '1. 000, oo(f
<br />. 4.000,000
<br />,-
<br />.
<br />
<br />A
<br />1---
<br />
<br />BOP-00001702711-01
<br />
<br />e/1S/2004
<br />
<br />6/10/2005
<br />
<br />COMBINeD SINGLE llMIY
<br />IE.aCIaid,,"l,\
<br />f--_. -
<br />BOOll Y INJURY
<br />(POIpllIlO1l)
<br />--
<br />BODll Y INJU~Y
<br />(P"lCeldenl)
<br />
<br />,
<br />.+-----..-
<br />
<br />,
<br />
<br />.
<br />
<br />~~G1E LlA8ll1TY
<br />.....j ANYALJ''I'O
<br />
<br />pl];1 .. /
<br />V&~7 II C,
<br />
<br />PROPERTY ~MAGE
<br />(P....ocldanO
<br />
<br />,
<br />
<br />1, 0001 000
<br />
<br />AUTOoNlV,EAACCIQfNT $
<br />,. ""
<br />E"Ace ,
<br />
<br />onER THAN
<br />Al/TOONlY
<br />
<br />UCE&5lJABJUTl'
<br />tij'OCCLll 0 c""'M.....,.
<br />a
<br />-I OE.OlJC1IBLE
<br />")rl RETENTION i 10,000
<br />WORKeR& COMPIiNS"ytoN NIl
<br />eMPLOYERS'LUtJIlUTY
<br />
<br />EACH OCCURflENCE
<br />
<br />,00 ,
<br />, 1, Ob~_'...~
<br />s_..~~..O.~
<br />,
<br />
<br />AG<lREGATE
<br />
<br />SCU-002602-02
<br />
<br />a/15/200~
<br />
<br />6/15/2005
<br />
<br />---~-_.
<br />.
<br />
<br />OTHliR
<br />C P~O~ES310NAL LIABILrTY
<br />
<br />SPL-0008680
<br />
<br />)/25/2004
<br />
<br />3/25/2005
<br />
<br />_lTo~~,GJITs I .. 10~..
<br />~~.~ceIDEI\IT '"~ I
<br />E l_ Dl6EAS~ . EA EMPlOYEE :Ii
<br />e.l. OI6EASE, POliCY iAIIT S
<br />$1,000,000
<br />55,000 DEDUCTIBLE
<br />
<br />-..--.-
<br />
<br />DESC:A,IPTlON Of oPEAATIOlIlISILOCAYIONSNEHlCLli.SlEXCLUllON8 ADOID ay ENOOIIII!MENTlSPEclAL. PAOV.SION5I
<br />
<br />10 DAY NOTICE OF CANCELLATION FOR NON PAYMENT
<br />THE CITY OF SANTA ANA, ITS AGENTS. OfFICERS AND EMPLOYEES ARE NAMED AS ADDTIONAL INSURE US
<br />( SEE A'r'rACHED FORM)
<br />
<br />CERTlflCATE HOLDER ~ [.aDDlTIONALft&URE1D;INSuRERLETT2R:
<br />
<br />C/>.NCELLAYION
<br />
<br />CITY OF SANTA ANA
<br />WORKERS COM?ENSATION CLAIMS ADM.
<br />20 CIVIC CENTER PLAZA ( M-411
<br />SANTA ANA, CA 92701
<br />FAX: 714,-647-5311
<br />
<br />ACORD ~5.s j7/U)
<br />LM" LPW v'.8.8 01' 91'4/04. 'ij,4IbyU_~
<br />
<br />&HOUUJ It.NY of 1'HI! MOVE DE,5CRIB!tl POUCIIi:I5 Be: C,&NCIiU.iED IlEPORE THE &::)(,.,,,,,,TION
<br />DATIE THEREOF, THE I5liUlNO INIU~R WIU. E~jrO WUl ~ DAYS WRITTEN
<br />NOnc. TO THE CE.ViAe,T. HOUJO. '-0 TO VHElEFT, 0;.;.""'",,-,r/0I> W"Il"'-,
<br />/"'f<t!'1 'f' "'M'H rf'<1-'f.;..1V/o; M/II f.';o!o1<14t{o Jro/4uIR/rr;. }t/E'T~ -..
<br />'1/1' ~ '/7'
<br />
<br />~UVr-x("" ~R_
<br />
<br />I 7
<br />
<br />~ ACORD CORPDRAnON 1...
<br />
<br />LP.lPW \/1.9,8 on W10111/04. 10.<49 by u..l'f\.lIlnte
<br />
<br />PFv1.0.1
<br />
<br />10 39\1d
<br />
<br />I ^\18 HInDS l\1INDlDJ
<br />
<br />Z:lS0ELG01E
<br />
<br />Ll:Z:l ~00Z:/~1/G0
<br />
|