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<br />
<br />"Marsh USA Inc.
<br />
<br />2/11/03
<br />
<br />10:01
<br />
<br />PAGE
<br />
<br />2/2
<br />
<br />RightFM
<br />
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<br />CERTIFICATE t1UMe~ 1:
<br />A 1l-OOC791153-11
<br />THIS CERTFICATE 18 ISSUED AS A MATTER OF INfORMATION OH Y AND CCNFERS .
<br />NO RIGHTS UPON THE CERTIfICATE Ho..DER OTHn: TH~ THOSE PROVIDED iii THE '
<br />POLICY. TH&! CERTFICATE DOES NOT AMEND, EX reND O~ AL TE~ THE COVERAGE
<br />N-FORDED BY THE POLICES DESCRIBED HEREIN_
<br />
<br />PRO,UCER
<br />Mareh
<br />3475 PiedmD" Road N.E., St. 1200
<br />Atianta, GA 3.)305
<br />4C4-S!&3000
<br />
<br />Attn: Brenda Voung.E.pps
<br />75142-CAS-
<br />
<br />IilSURED
<br />
<br />Scantron COfpOfStion
<br />34 Parker
<br />Irvine, CA 92618
<br />
<br />COMPANIES AFFORDING COVER ~GE
<br />
<br />(404)995-3074
<br />
<br />CCHi=lHojY
<br />A FEDERALlNSURANCE CO
<br />
<br />,
<br />
<br />-1
<br />
<br />COI'1PiNY
<br />
<br />C~~y -----j
<br />~'~i.tl%"'iZll. .' . '!l!i*~~mU1iilil;ilH7;;j~ 1
<br />
<br />THIS IS TO C:RTIFY THAT PO--IOES OF INSJRMlCE OEs:::RIBED HERSN HAVE BEEN I.fBJED TO ~E INSJRED N~EJ HEREIN FOR. .. HE PO ICY pr:RIOD INQIo:ATE'D
<br />",arV"ITHsrANOING A~IY REWIREMENT, TERM OR CONOITlCJ>j OF ANY CONTRACT CR OTHER OOCUMENT\o\1lH RESPECTTO\M-'IQ-! THE CER.'I~ICAT~ W I>Y EE IS-O:U=J OR 11,1."
<br />PERn"JN, T.-lE INSJRN.CE AF~OROEO BY THE POuaES OE:s:::RIBED HER8N IS SUBJECT TO JrtL THE TERMS. co~omQ\ls AND EXO.USQ\S CF W()' POJO;:;S AGGF:EG/ITE
<br />LIMITS 9-iOlM MAY HI-VE BEEN REDUCED BYPJiI~ Q..A1MS
<br />
<br />co
<br />LTR
<br />
<br />mE OF INS:JRAHCE
<br />
<br />ca.1PHoY
<br />B AMERICAN IN1l SOUTH INS. CO.
<br />
<br />POLICY NUMBER
<br />
<br />POLICY EFFECTIVE ~OLICY EXPIRATICH
<br />DATE (MMIDDfYY) DATE (MMrooNY)
<br />
<br />L1nrrs
<br />
<br />CoT'=
<br />i ER
<br />
<br />I
<br />
<br />2,0(JO,C~
<br />20i)O~~~J
<br />1 O')),COO
<br />1 o,)J,cCij-
<br />----j
<br />10')),CCKII
<br />'1QCCii1
<br />'_~~~~~
<br />
<br />$
<br />
<br />$
<br />
<br />=J
<br />
<br />A
<br />A
<br />
<br />OEtlERAL UABILITY
<br />~_'_';"F:MERaJrt GE:NERAI... LIABILITY
<br />d'~'; Q..AlMS MJ[IE ~ OCQ.lR
<br />QM>.ER'S & CGtrRACTOR'S PROT
<br />
<br />
<br />,frIJrOMCElLE LIABIUTY
<br />
<br />X \ I-NY Al...TO
<br />,ILL CJ.o'o.NED AJT'JS
<br />s:HEOULED AUTOS
<br />HIR;D AUTOS
<br />NQo.I..Q\M.jED Au-rQS
<br />
<br />35381324
<br />35381324
<br />
<br />01/ll1/03
<br />01/01/ll3
<br />
<br />03101/04
<br />03101/04
<br />
<br />$
<br />PROCUCTS .IX:J.i\PfQP I-.GG $
<br />$
<br />$
<br />$
<br />$
<br />
<br />$
<br />
<br />$
<br />
<br />
<br />I
<br />:==~~]
<br />f~O!)J~~~~~
<br />5,O()J,CQ(~
<br />I
<br />
<br />~,~_..~~
<br />-';;ftrf]~:%'ThlHmnJi!tj:,!
<br />$ _~ O'~~~IJ
<br />$ 101}JCCK.l,
<br />$ 1'~~~~1
<br />
<br />DESI:;RIP--ION OF OPERATICINS/LOCATlONS!VEHICLES/SPECIAL ITEMS
<br />The City of Santa Ana, its officers, employees, agents, and representative are induded as additional insured as their interesl may cppeaJ per 'J/Titton l;or:tr;;irt.
<br />
<br />A
<br />A
<br />A
<br />A
<br />A
<br />
<br />B
<br />
<br />GAltAOE LIABILITY
<br />__I~'.'LTO
<br />
<br />
<br />EX CESS LIABILITY
<br />
<br />GENERAL I-GIREGAT=
<br />
<br />PERSONJrt & \DVI;>.jJU~Y
<br />
<br />EA~ QCOJR ~ENCE
<br />
<br />FIR:: Q"\lAGE (AnyOl ~".~
<br />
<br />Mea EX::' (An~ rnepe'OO'IJ _
<br />
<br />73260213 (ADS)
<br />73260209 (lX)
<br />73260210 (VA)
<br />73501034 (MA)
<br />73260212 (PR)
<br />
<br />01/01/ll3
<br />01101/03
<br />01101103
<br />01101103
<br />01/01/03
<br />
<br />03101/04
<br />03101104
<br />03101104
<br />03101104
<br />03101/04
<br />
<br />BOI11LY IN~UR ~
<br />(Pe' accident)
<br />
<br />x I LI~3'<,EL_A =CRi'w
<br />
<br />aTHER THAN UM8RELLAFORM
<br />A WO~KERS CO!ilPEftS,
<br />I EMI'LOYERS'LIABILITf
<br />
<br />: THE' PRO~IETORI
<br />PAF:TNERSEXEaJTlV;
<br />O=;Ic:s;,S ARE
<br />itl"TR':.R
<br />
<br />COMR~EO S.JGLE LIt/IT
<br />
<br />BOOIL_YIN~U"'f
<br />(Perp<<r,cn:
<br />
<br />PROPERTY D,MAGE
<br />
<br />AJTO O\lLV.. ~.'ACa1ENT
<br />OTHER THAN ".JTOOlilY
<br />
<br />BE29l18318
<br />
<br />EJ Ol ....CCIDE...T $
<br />$
<br />$
<br />$
<br />$
<br />
<br />AGGR!:<3 "TE
<br />
<br />01/01103
<br />
<br />03101104
<br />
<br />EAOl OCCUR lE\lCE
<br />
<br />AGGREGATE
<br />
<br />35381324
<br />
<br />03101104
<br />
<br />Sir '~~
<br />X .feRV Li\ ~fs
<br />EL EACH Aca Ji3\lT
<br />
<br />01101103
<br />
<br />>NO.
<br />
<br />F.L DlEEI.s;-P' LICY ll-oJlT
<br />F.l O:::EME-€, 01 E~PLOYEE
<br />
<br />EXa.
<br />
<br />~e'IT"lCA-JtPl;I!~~'" <~" 'SI,".m' "=.~,.... ... ...".... ..'
<br />< ~nJI"};.:,-"",:t,\ ;;_";',,, J~}t'" ': ",,;-,:~W&tmf:t:;,^:'_::_ :::-}f;, ""c_"";%>v,;:~--' jW~ ,-_ --,:--:-.
<br />.. ...., ..'.m ... ....=_ ..:ffi!?t~.... . ...
<br />APPROVED AS 10 fO
<br />
<br />
<br />._.,""~
<br />"IIIIII:II:lllfmRm,illl~%j:;I_$Si~!:I]~mlmUM U: Hel
<br />9iOU.CI....tl'{ OF TI-E POlIOES nESOU!lEDI-EREIN erE: CANCl" _LEO I!IEF(IIl.E TI", EXF'I::..TiOll: D....r; 1-1E':I'CF
<br />IN9.JIER AFFORDING COVER,o,a: \'~lL E~,,*~ 'oWL --3.Q rM'I'll WRlmN NO- Cl" 1(' -""',
<br />
<br />City of Santa I~na
<br />20 Civic Center Plaza
<br />P.O. Box 198f1
<br />Santa Ana, CA 92702
<br />
<br />
<br />CERTiFICATE HeLDE'1 M'.II.ED HERE'N, Bur F"LURE ~o M/lIL ! JCH ~IOTC:: .5H~ L III,P:>>:l'" r-M:' OB~IQ'1l('" ':11 i
<br />
<br />I5SUeROI'"THSa:Fl1lFICATE
<br />
<br />W,o,BIUTYOI' ,o,tl'{1(11'l) LPONTH: IN!'Ul.i:i\ IJ'FORDIN<; CCWERJ GE, ITS Aa;NTS (,Fl R=~'~"'SENTAT \..~; 0'1 IH1' i
<br />.--..)
<br />
<br />Laura Sheedy
<br />L. ,. <;ly City Attorney
<br />
<br />ARat USA"C_
<br />y: Michael Dennis
<br />
<br />;/H-t-I,,1-
<br />";;;::;;1"';;]"';& "" ,iIi'l,Sps i~{,fiRl;::.. !' .. i' .
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