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(.-[.Lis 01 INSI, .I _ ._l EE'.vN . nF, N Imo ',Hf„ SINS, R , NAMED Au- FORTt It ac 1,wPERM NOIV CA D. NO I W yIIS;'ANL Nib
<br />,.rIREMEV IrGla J;H ..,ONIL T.CN .�' , E ,,GN'FaL GR 3fHER M00_,I NI ,ITti RESPrOT TV N ;I i iE CERTIFICATE MAY SE S5UF5 CR
<br />IA! ETI 14iN. F N ,R�1NCii1ICi7's c ,S LIRBED NF_ L N IS SI,B,A 10 A�',,7 MS hl t US . IS ANI, O m FI CI I_ QF S, -H
<br />('I a. AGG, t S ="111T5 FO;i I ; AY HAr [ iN REDI" CIE ` 3Y 'AID
<br />Ih[ TYPE OF INSURANCE POLICY NUMBER
<br />IOCCY EFFECTIVE ROurY EXPIRATION LIMITS
<br />0#i=(MMIUUIYYV
<br />GENERAL LIABILITY 6011408514
<br />04121710 04I21;17
<br />each oauRr. nice >
<br />1,000,000
<br />X dP1E:'IAI.rzE .` 4ltidL;TY
<br />as A cr - 9
<br />sa,0oo
<br />I>US>IA„F® JJ_ai'
<br />MED RxP \ry e,o aen"',
<br />A
<br />PERSONAL 3.ACV IN.IURY
<br />1,000,000
<br />"ENERAE AG3REGA IE i,••,�•,•••2,000,000
<br />,,EI,N L A'dOREG.ATE At,11' APPLIES PER.
<br />PROCOC rS"CIJMP CP AGO 3
<br />2.000,000
<br />Rn Lj X AOLbCti ,F1 LGC
<br />7-
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE EMI!
<br />lnY N.j*0
<br />ra BCC:QLrO S
<br />AL L I 11Cf AUU"Sy�
<br />ROSILY IN:URY
<br />S,;HEO,LA, �3
<br />N
<br />a;
<br />HIR I J5
<br />BODILY IN URY
<br />NnP O NEC AOS
<br />3 I .
<br />1 I
<br />PROPER TY CAt,IAUE
<br />NWL
<br />P ac a
<br />GARAGE LIARILI T Y
<br />�P
<br />t�, nn
<br />b y
<br />AUFG ONLY-E4 ACGISHRr 3
<br />.YIV AUTO
<br />Y�i{
<br />e�t� i
<br />if�j'
<br />OTHLie TUAN EA ACQ E
<br />y{L
<br />L"'
<br />1ltTlJ ONLY AOG 3
<br />EXCESS I UMBRELLA LIABILITY
<br />-Atb'i OCCURRENC@ B
<br />OCCUR � CLAIMS MkOF.
<br />#.+41ftEGA7E
<br />DEDUILT TOLE
<br />_-..__..,,........,,..�.,
<br />RETENTION 3
<br />7
<br />WORKERS COMPENSAi1ON AND 9059$81.16
<br />1
<br />ad)22.95 aA12217
<br />'ur 5=avu - �
<br />X R-_cars
<br />BMPLOYERS' LIABILITY
<br />r +cin.clnENr a
<br />1,000,000
<br />AN4 PRCPRIE(CR.PAF NER Y6GOTI`fE
<br />OFrICBRHdEM6EN Ex- V16m
<br />F DRE.11SE EA EMPLOYEE, S
<br />1,00,000
<br />If 1ne, ;IaYpSo undo+
<br />SPECIAL PROVISIONS bc,—
<br />i. OL!HASE,ROLIGYLIMIT 9
<br />1i01)0,000
<br />OTHER:
<br />DESCRIPTION OF OPERATIONSI'LOCATIONSIYEH IC LE&EXCLUS IONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
<br />Certificate holder, its officers, agents, and employees are named as Additional Insured in regards to General Liability per attached
<br />SS•14M2•E i All terms and conditions are based Upon the actual
<br />policy
<br />r*
<br />CERTIFICATE, HOLDER
<br />CANCELLATION
<br />.R^6 L > .' N -hE A,9—)LI",, A
<br />°.'HE
<br />City of Santa Ana
<br />AIM: PRCSA
<br />'=I �_.. •'a` -'-
<br />20 Civic Center Plaza, Santa Ana, CA 92701
<br />Attention;
<br />JDy Loe
<br />ACO2D CORPORATION 1983
<br />
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