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<br />W Certificate oflnsurance
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<br />'his l;er1lfkat'~ is furnished to you as a matter Ofinform~i~n~~:.~~~~ ;o~a~~u~:~~~~~S~he issue of this cet1lflc~,te docs not amend Of aLlf 'lie ji
<br />IIJv~rage affOlded by the policies listed on Ihe: ccrtiticutc. Notwithstanding llny requirement. lenn or condition of any contral~t or other document wilh ;'C: "Cl I
<br />~.:~hich this (eniDcll.te i,~~sued, the: insurance afforded by the policies listed on thiS cert.ticate is subject to aU teons of such policies. ::=.:~:~.=:
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<br />[~:hiS ccrtifi(:a!,) cancels and supersedes any and all priorcertifkate5 issued on behalf of the named in:surcd to Lhl:: ee:rtifit;8.le holder desigllllted helm" .._ ..___1
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<br />< <ERTlPI('AIJ'1t I city of Sauta Ana ISSUING upeo. Xavier Ornc:as ..- "--1
<br />,'~g~~i;s~r,D 20 Civ'..c Center Plaza ~g~~~~~AND HewJett-Packard Company I
<br />I:,a:'lta Ana, CA 92702 PERSON: 2125 E. Kat,,'lla ~l.VI~,
<br />Suites 400
<br />__ Anaheim, CA 92B06 = .. J
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<br />[;oc-mON~[ Same as certificate holder II TELEPHO~[: II (562) 480 - 9360 I
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<br /> J Policy POIi" I
<br /> (:oYcl1lge Company & Policy Numb~r ErrcctiveDale E1(1lrltlonDIIIf' LimitofLiabilit;
<br /> (mm/dll/yyyy) (mm/dd/YlYY)
<br />'t'ORKERS' COMPI<:NSATlONI Old Republic Insurance Co.: 9130/2006 9130/2007 Statuto!)' Workers'
<br />I:MPLOYEIlS' LIABILITY MWCII 187900 Compensation Limil:;
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<br /> a. Ail St;.te::Coverage Employers' LiabililY . ~t :
<br /> b. U,S, lon~shoremen & Harbor All stales except CA, W A, CO, I Each Accident Ir;;.oo'
<br />"lockers and OR
<br /> c Maritime
<br /> [";""'.E"h toc;
<br /> Work Comp excludes WY, WV, J:mploycc
<br /> OH, and ND U.,;'''". [:0:
<br /> Policy Limit
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<br />''OMPREHI NSIVE (.;ENF:RAI, Old Republic Insurance Co.: 9/3012006 9/3012007 ljodily JnJury/Proper<y I
<br />;, IABILlTY, lNCL PfRSOl\'AL MWZY 57279 I Comb;,," S;081, lAm;!
<br />:IIl,Jl:RY & PROPERTY ~,2. 500 ,000 Per Occlfre,
<br />OAMAGE IJI'CL.: I
<br /> fl Premi~c5, Operation';
<br /> b lnllcptlxlentContrw.:tur I~~b
<br /> {; Cuntrllct:al Llabi]it" -;:.:r~
<br /> d Compiehd
<br />i 'pe-rlltions,'Pr'ldu~l~ iL
<br /> e Exp)o~io'l, Undcrgr'.>und &
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<br /> (XCl.JtO\erage)
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<br /><ITO~'''''W'J Old Republic Insurance Co.: 9/30/2007 Bodily InJury/Property {
<br /> a Owner Vehicles MWTB 19639 Combined Single LhCiil
<br /> b L.ease, VehIcles I ~,2.500,OOO Per ACClderJ
<br /> \; Hl(cd '/t~llt;lt:s I,
<br /> d Non-oNn;dVehlcles
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<br />i::X CESS I.l~ BrUTV Tall Tree Insurance Co,: 9130/2006 9/3012007 n 5:500.000 Combined Sim
<br /> 470-IXL0027 ~~ Limit ExceS5 ofS2,51)C,(
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<br />IfEWLETr-PACKARTJ CO
<br />3000 HAt\OVI-:.R STREET
<br />I ,.___PALO ALTO, CA 94304
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<br />:[ ~e. In the e~eJ1l [If cmlCf!lluti01f of the above described policy, 'he issuing comptufy will endeavor to gfve 30 days prior writun notIce to the ccnif; : r=:
<br />I 'rllder
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<br />! .;A.'\1EDI~S~iDADDRESS; AUTIJORlZED REPRESENTAnVg: '--- ..--
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<br />Dateluued: 1/31/2007 )
<br />Minh Risk Mnd InmranceServiees, Tnc.
<br />777 S. Figueroa, I.os Angeles. Ca, 9!),(~n!'. (213) 3'i6-:;~ :1==.
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