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<br />" <br /> <br />87~25/2BB5 B2: 41 <br /> <br />714544573B <br /> <br />L.A TCiU~ETTE ST {HE F AP <br /> <br />PAGE B1 <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />o STATE FARM FIRE AND CASUALlY COMPANY, Bloomington, illinois <br />121 STATE FARM GENERAL INSURANCE COMPANY, Bloomington. Illinois <br />o STATE FARM FIRE AND CASUALlY COMPANY, Scarborough, Ontario <br />o STATE FARM FLORIDA INSURANCE COMPANY, Wlnt.r Haven, Florida <br />o STATE FARM lLOYDS, Dallo$, Texas <br />in$ures the following pOlicyhoider for the coverages indicated b.low: <br /> <br />Policyholder John Campbell r DBA Benefit Fundi",9' Service Group <br /> <br />';a. <br />,..,Wh~~" <br /> <br />This certifies that <br /> <br />Address of pollcyholdar <br /> <br />location of operations. <br />DeSCription of operations <br /> <br />2040 Main Street St€ 150, Irvine, CA 9261'1 <br /> <br />The policiea lIated below have been issued to tile policyholder for the policy periods shawn. The insurance described in the~ policies is <br />subject 10 all the lerms, exciusions, and ccnd~ions of those policies. The Iim~ of liability shown may have been reduced by any paid claims. <br /> <br /> POLICY PERIOD LIMITS OF LIABILITY <br />POLICY NUMBER TYPE OF INSURANCE E~tiv& Date : ExpIl1IIfon DatI9 (at OOginnlng of policy period) <br />92-YG-4106 2 G Comprehensive 7/08/05 , 7/08/06 80DIL Y INJURY AND <br /> , <br /> .8,:~i~.~~~.~!~bil!!>, ......... _"h. .... ....h ..Lmoo.m........ PROPERTY DAMAGE <br />. - This insu-mnce- i';Ciude.A:. -. o Products. Completed Operalions <br /> o Contreclual Liability Each Occurrenca $?,OOO,OOO <br /> o Pen:onallnJury <br /> o Advertising Injury General Agg",gate $!, 000, 000 <br /> 0 <br /> 0 Products - Compieted $101,900 <br /> 0 Operations Aggregate <br /> POLICY PERIOD BODilY INJURY AND PROPERTY DAMAGE <br /> EXCESS LIABILITY Effective Data : Ellp/r.dIon PaID (Combined Single Limn) <br /> o Umbrella Each Occurr&nce $ 5000 <br /> o Olher , Aggregate $ <br /> POLICY PERIOD Part I - Workers Compensation _ Slatutory <br /> Effective Date i Elcplr.lllorl Dale <br /> Workers' Compensation , Part II - Employers liability <br /> , <br /> and Employe", liebility , Each Accid.nt $ <br /> , <br /> : Disease - Each Employ.e $ <br /> , Disease - Policy Umit $ <br /> , <br /> POLICY PERIOD LIMITS OF LIABILITY <br />POLICY NUMBER TYPE OF INSURANCE Effective Dale : ExpIl1IIfcn PaID (ot beginning of policy periOd) <br /> : <br /> : <br /> : <br /> <br />TilE CERTIFICATE OF INSURANCE 18 NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATlVEL Y <br />AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. <br /> <br />Name and Address of Certificate Holder <br /> <br />If any of Ihe described policies are canceled before <br />lheir expiration date, Slele Farm willlry to mail a <br />wrftlen notice 10 the certificate hold.r 30 days before <br />cancellation. If however. we fail to mail such notice, <br />no obligation or Ii bllity will be Imposed on State <br />Fa lis a en or Ie r.senlallYe <br /> <br /> <br />(Additional ~n3ured) <br />City of Santa Ana <br />20 Civic Center. Pl~~a <br />Santa Ana, CA 92701 <br /> <br />SIgnature of AUlhortzed Representative <br />AGENT <br />irlle <br />Ken L~ Tou.r.ette <br />Agenl. Name <br />Telephone Numbe.- 7).4/541- 3 7 7 9 <br /> <br />Agent's Code $temp <br />Agont Cod. 8906 <br />AFO Codo "41 8 <br /> <br />1125/05 <br />Date <br /> <br />658..gg4 a.S R~. 11-09-20OA Prlnted In U.S.A. <br />