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THE HARTFORD <br />.•+ INSURANCE GROUP <br />HARTFOPE3, CONNECTICUT <br />'This is to certify that tl <br />CERTIFICATE OF INSURANCE <br />Har Fire Insurance Company <br />V 31 Har,4- -,1 Accident and Indemnity Company <br />M Hartford Casualty Insurance Company <br />Ye company designated o. i Code <br />York Underwriters rwriter Insurance Company <br />a City Fire Insurance Company <br />herein by Co. Code has issued to the named insured Named Insured and Address <br />the policies entimerated below. <br />SADDLEBACK IMT, SANTA .N, TNC <br />1650 EAST FIRST STO <br />SANTA ANA. CA* <br />The policies indicated herein apply with respect to the hazards and for the coverages arid limits of liability indicated' by <br />specific entry herein but this certificate of insurance does not amend, extend Or otherwise alter the terms and condition <br />Of the insurance coverage in the policies identified herein. <br />Hazards <br />General Liability <br />Prern ises- Operations <br />Independent Contractors <br />Completed Operations; <br />Products <br />Contractual as described <br />below <br />Policy Number <br />and <br />Policy Term <br />cBP 800116 <br />07/30/73Z76 <br />T <br />11 <br />31 <br />Policy Number <br />Hazards and <br />Policy e'er <br />Automobile Liability <br />Owned Automobiles <br />Fired Atztor ,obiles <br />Ton -Owned Automobile <br />Workmen's Compensation <br />and <br />Employers' Liability <br />Umbrella Liability <br />Coverages and Limits of Xabxllity <br />(SINGLE LIMIT <br />Bodily Injury and <br />Property Damage Liability <br />(DUAL LIMITS) <br />Bodily Injury Liability Property Damage Liability <br />each occurrence <br />occurrence <br />a ,�regate <br />occu nce <br />aggregate <br />X000 <br />O ,000 <br />,000 <br />XXXX <br />,000 <br />,000 <br />�.... J00 <br />,000 <br />XXXX <br />,000 <br />,000 <br />i 300 ,000 <br />0 x000 <br />x000s <br />000 <br />'OOOS <br />000 <br />x0001$ <br />000s <br />000 <br />XXXX <br />000s <br />000 <br />Coverages and Limits of Liability <br />(SINGLE LIMIT <br />Bodily Injury and <br />Property Damage Liability <br />*each <br />occurrence aggregate <br />,000 XXXX <br />XXXX <br />0MOM <br />{DUAL LIMITS <br />Bodily Injury Llabi ty Property Damage Liability <br />each person <br />*each *each aggregate <br />occurrence occurrence <br />�000 ,000 XXXX <br />—,000s 000 XXXX <br />0008 000 XXXX <br />Compensation — Statutory <br />Employers' Liability — ,000 <br />,000,000 <br />*If with respect to Automobile Liability the Policy Number entered above includes the symbol GB, AZ, MVP, MAG or PGB, the Ford "occurr nce" <br />is amended to read "accident". <br />. <br />Location and description of Operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and <br />cute.) PEDESTRIAN BRIDGE AT SAIMLEBACX IRT, SANTA ANA, C.. <br />If policy is canceled, 3 0 days ; CITY OF SANTA ANA <br />f r- ; itt n notice x�� given ��: {} CITY ATTORNEY <br />CIVIC CENTER PIAZA <br />A 91976 �.�� ANA, CA, <br />PM X <br />J* <br />� 6 ` r( { /// ♦ ♦fll 11 3 1 f jam/ <br />l { ' <br />uthori r e v <br />4 <br />Fornx Ad'X- Printed in U. S. A. <br />