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<br />BONDBLACK
<br />
<br />, CERTIFICATE OF LIABILITY INSURANCE T DATE (MM/DDIYYVY)
<br />ACORDTM 8/21/2007
<br />PRODUCER Commercial Lines - 831-431-2300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> ABD Insurance & Financial Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br /> 5615 Scotts Valley Drive
<br /> Scotts Valley, CA 95066 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Bond Blacktop, Inc. INSURER A: National Fire Insurance Co.lHartford 20478
<br /> P.O. Box 616 INSURER B: Transportation Insurance Company 20494
<br /> INSURER C: Redwood Fire & Casualty Co. 11673
<br /> INSURER D: American Cas. Co, of Reading 20427
<br /> Union City, CA 94587 INSURER E:
<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 MAYBE 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 />INSR ~~~ TYPE OF INSURANCE POLICY NUMBER Pc?}{~';~~~~8,w\E Pg~fl ,i,~IroiWN LIMITS
<br />LTR
<br />A ~NERAL LIABILITY 2077702038 05/06/2007 05/06/08 EACH OCCURRENCE $ 1,000,000
<br /> X 3MMERCIAL GENERAL LIABILITY ~~~~~U9~~';,~~~Qn"Q\ $ 300,000
<br /> - CLAIMS MADE 0 OCCUR
<br /> - MED EXP (Anyone person) $ 5,000
<br /> X PD Ded: $2,000 PERSONAL & ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> n'L AGG~~E LIMIT APnS PER: PRODUCTS - COMP/OP AGG $ 2,000,000
<br /> POLICY X j~8T LOC -.....
<br />D ~TOMOBILE LIABILITY 2077702041 ~'P ~~ ~ L 0 06/08 COMBINED SINGLE LIMIT $
<br /> ~ (Ea accident) 1,000,000
<br /> X ANY AUTO ( ~
<br /> ~
<br /> ~ ALL OWNED AUTOS ~ BODILY INJURY
<br /> $
<br /> SCHEDULED AUTOS O?-C"'- (Per person)
<br /> >--
<br /> ~ HIRED AUTOS \..\S~ t. S~ ~O{(\e'J BODILY INJURY
<br /> ~\\'J ~ $
<br /> X NON-OWNED AUTOS (Per accident)
<br /> ~ ~S\S\a(\\
<br /> ~ PROPERTY DAMAGE $
<br /> (Per accident)
<br /> RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
<br /> ANY AUTO OTHER THAN EA ACC $
<br /> AUTO ONLY: AGG $
<br />B 0ESS/UMBRELLA LIABILITY 2077702055 05/06/07 05/06/08 EACH OCCURRENCE $ 9,000,000
<br /> X OCCUR D CLAIMS MADE AGGREGATE $ 9,000,000
<br /> $
<br /> M DEDUCTIBLE $
<br /> X RETENTION $ 10,000 $
<br />C WORKERS COMPENSATION AND W6A36966 10/01/06 10/01/07 X WC STATU-, I IOJ~-
<br />EMPLOYERS' LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000.000
<br /> OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000.000
<br /> If yes, describe under
<br /> SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT S 1,000,000
<br /> OTHER
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />The City of Santa Ana, its officers, employees, agents & volunteers shall be named as Additionallnsured(s) as respects General Liability Dnly per the attached
<br />endorsement form G-140331-A99 with respects to Location: Vacant lot @ southeast corner of Walnut Ave. & BristDI St., Santa Ana (APN #008-224-18, 19,28)
<br />*Cancellation clause is in force per the attached endorsement form G-15115-A*
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION Ten Day Notice for Non-Payment
<br />
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br /> DATE THEREOF, THE ISSUING INSURER WILL 1lfl1Oli<<lIaIlRJllX)(Ia,IL 30 DAYS WRITTEN
<br /> -
<br />City of Santa Ana NOTICE TO THE CERTIFICATE HDLDER NAMED TD THE LEFT, ~~I(
<br />Public Works Agency 1~J0e4)4l5ll1lJ0111:~~~;m,:~xx
<br />20 Civic Center Plaza ~
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE %. ~
<br />
<br />ACORD 25 (2001/08) 1 of 2 62694
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<br />@ ACORD CORPORATION 1988
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