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M <br /> CERTIFICATE , <br /> OF INSURANCE LIBERTY 7--.:117----.41 <br /> MUTUAL ® <br /> L IBIRTY MUTUAL IMSUFAHC!COMPANY N IIBERRY MUTUAL FIRE INSURANCE COMPANY N TOT TOY <br /> This is to Certify that <br /> PSCA Services Inca and 1 <br /> Great Western Reclamation Company Name and <br /> P. 0. Box 2337 4-40 address of <br /> Santa Ana, California 92707 Insured. <br /> is, at the date of this certificate, insured by the Company for the types of insurance and in accordance with the limits of liability, <br /> exclusions, conditions, and other terms of the policies hereinafter described. This certificate of insurance neither affirmatively or neg- <br /> atively amends, extends or alters the coverage afforded by the policies listed below. <br /> EXPIRATION <br /> TYPE OF POLICY DATE POLICY NUMBER LIMITS OF LIABILITY <br /> COVERAGE AFFORDED UNDER W.C. LIMIT OF LIABILITY-COV. B <br /> w01-61 2-0041 35—o16 LAW OF FOLLOWING STATE(S): AL, AZ, <br /> WORKERS' AR, CO, CT, DE, FL, GA, IL, 500,000 <br /> COMPENSATION 1/1/79 <br /> WC2-612-004135-04 INNY <br /> W02-612-004135-066 IN' NCIA' KY' LA' MD'OKORPASCMI, , $ 100,000 <br /> TX, <br /> 9 ) 7 c8 7 TN, <br /> TX, WI, MA, CA, MB, NO. (INDICATE LIMIT FOR EACH STATE) <br /> I-Z COMPREHENsrvE BODILY INJURY PROPERTY DAMAGE <br /> FORM $ <br /> EACH EACH <br /> Ell SCHEDULE FORM $ OCCURRENCE OCCURRENCE <br /> 1/1/79 LG1-612-004135-026 BL & PD COMBINED $ 500,000 per occurrence <br /> PRODUCTS CO <br /> Q LSI PLETED OPERATIONS $ AGGREGATE $ AGGREGATE <br /> w — <br /> Z Q INDEPENDENT-CON- <br /> ❑ T R ACTORS/ECTIVE O <br /> TORS PROTECTIVE <br /> CONTRACTUAL <br /> LIABILITY <br /> >- OWNED <br /> a a NON OWNED 1/1/79 AEI-612-004135-036 $ 500,000 SINGLE EJoNOCCURRENCE <br /> HIRED ?ODILY INJURY &o DAMAGE CO aiieEN el <br /> _C <br /> Lir • <br /> I <br /> H <br /> 0 <br /> LOCATION(S) OF OPERATIONS & JOB # (If Applicable) DESCRIPTION OF OPERATIONS: <br /> _J <br /> J <br /> "City officers, agents and employees are named as additional insureds." <br /> NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF <br /> DAYS IS ENTERED BELOW). BEFORE THE STATED EXPIRATION DATE THE COMPANY <br /> WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES <br /> PRIOR TO 30 DAYS AFTER NOTICE OF SUCH CANCELLATION OR REDUCTION HAS BEEN <br /> MAILED TO: <br /> City of Santa Ana, City Attorney's Office / ti <br /> 26 Civic Center Plaza1,-r7-7/4/^A- L r� <br /> AUTHORIZED REPRE Y TATIVE <br /> Santa Ana, California 92701 11/2 $ Bostonsachuaetta <br /> L DATED OFFICE <br /> This certificate Is executed by LIBERTY MUTUAL INSURANCE COMPANY as respects such insurance as Is afforded by That Company,It is executed by LIBERTY MUTUAL FIRE INSURANCE <br /> COMPANY as respects such Insurance as Is afforded by Thai Company. BS 234A R7 <br />