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,r � OATF (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />. THIS CERTIFICATE IS rs51JEo AS A MATTER OF INFORMATION ONLY AND CONFERS NO R€61ITS UPON THE CLttlIFICAxE HOLbER. THIS CEJ3T#FICATE OM' NQTArF'IAMATIVELY OR NEi2A'TISlr_LY <br />AMEND, EXT-.NO OR AALTERTHECOVERAOEAFFwm BY tilt POLICIES BELOW. MIS CEWfIP€CATE OF (N SUAANC.£ DOES twr Cotw I'UTC A CONTRACT 65WIILN THE ISSUING INSURC-R(S), <br />A131 HORIZED REPRESENTATIVE OR PRODUCER, ANO THE CENTIFICAT£ HOLMR. <br />144POATAN'f,Irt4eccrtillcate'ltri€derisrahADDIIIONALINSURL0, 0polky{1e9)must€ roveADDrr1ONALINSURC-ppraalsiansor4eendorsedTFSUBROGATION ISWAWErD,sublecttothe tendswid <br />conditions of the 110j1q. Cer4aln ptelWasrnay tegtlirp. pp tt€dorime-ol. AsL'simeot on this cett(Acate noes lint confer rights to the4e4j icaio Inuidiir in lieu atsuch andaMemetit(i). <br />PRODUCER CONTAU _ <br />NAME, Wheel.BmiAorr <br />Michael Brandon, Farmers InsuTanoe .:. FF# PRONE I FAX <br />31629 Grater Fllahway 10 Ste A (Ali NO, CXT} 909 794 0191 (A/C NO) 909 Y94 0193 <br />...,.._----_.W____. ....._..._........ <br />_ <br />E-MAIL <br />arrsssccc. mS�r�nrinnlr74T�rnsarc.�rronl� nnrre <br />Redlands <br />J WAT R 1NC.. <br />12 f3COE)YEAR STE 130 <br />1RVINE <br />CA 92373 7b90 <br />CA 9261J <br />1'.kd1515 iL Clftih'r`itF.'a"F€1 Pt7laCIS €iWIhiSiiRLnM:G%!€51 PrJ'BELOVY.I4AV[iL^ EI�JTfi,"aUIJ TO THE iNSU <br />J1EC}UIR€ i�II .NT, T :RSA t xcoNurr€oN or ANYicor iTRAL'r Litt OTE-im DocumpoT wiTii RESpt;(xTov) <br />Pp1Tf'i:UF4i„€iIpERHEREIN 155UtIECTTOALLTHETERNIM,EVZLLA50N5AND CONDITIONS OFSUCH <br />ADDTL F..1113 1MR , R: <br />I.7R INSO W <br />TYiLS3EiMStiitAiVC£ VD ) Pf3LiCYNURi ER <br />... ...onir,...�rrti�l.rlr€u��AL�.j��s�.�rr •...... 1.��- <br />i <br />N"LAG REQNIELIMMAPPLIESfIEA: <br />L ,V POI-if."Y (, T UPIECT o., LOC <br />ooiru: <br />.-..� AUTi1MORlL4LJAt11LtTY <br />1 <br />ANY. LITO <br />SI„i•I££?ULLD. <br />IAUTOS <br />�" ..,..,.d. <br />i0VINEDAUT05 <br />oigw <br />i <br />i MREDAUTOS <br />t71vLY <br />- NG3Y•i3VdidFfi7 l <br />AuT& s aNty <br />:..— <br />......... .._........ __- <br />I UMBRELLALIA13 <br />-' OCC€R <br />1Mc IF1AI3E - <br />iiF_il__ .PL•:7'Entn;Jh'� <br />WORKERS COMPEN$ATiON. <br />ANLi.E MPLOYI RV LIABILITY <br />ANYPRoPMETOR/J:=ARTNER/ Y)tI NIA <br />£HECS1tIwE LTFF]( Elt/rt31 S�£ iclfi <br />FY�f%kiLii�O?{IvT�stdafiotyin NHj ... <br />tf yas, riescdhe sender D£3CWPTYS)N OF <br />543 <br />REVISION NUMINN:. <br />poucnm OULICY w <br />(MM/O0/YYYY) (MMrio/YYYY) LihS175 <br />FAr } I O(:CA1RltLPdCI <br />DAMAGf:' IDRENrrt3 .......,.. <br />PR�Cv11SE$(Fa ttrcurren�r),. ^ <br />.AVG r,,,'W (Auyone pemny <br />j f�c'RSCSidAL:J�.AtSst'IEVJVRY: <br />4iEA€:R.�t„�GiiEGATF <br />PRODUCTS r } AICiPAraG <br />(E� siCCISiLilil. <br />BODILY INJURY (Porrx,rson) <br />a t4tspEiYJ'VJUl�t(Pt�r�caekiel�tj <br />091041201.9 OWNPolo <br />PROPFRTY DAMAGE: <br />(Pu a�rilT+°rer} <br />i <br />EACH 67L•GBIRR NCE <br />- ' <br />PER OTHER <br />a IAi'.(,tIF <br />! F I EAC7 I Af,CIL�fJfl <br />jt L VN A,4E FA EMPLOYEE <br />ir[-La€SEs,�€ Fri]€lC'YLlivllT <br />11,000,{ <br />UkSCRIPT0NOFOPPRATIONS/LOCATJONS/VEHIICLES(ACORD 10I. Addi#Sanal Rar narks Schedule, waybe attached irtnare space Isrequirad) <br />.Additional Insured: City of Santa Ana <br />3O Days Notice of.cancollation with 10 Clays' nailJw ftar non -Payment of premium in acc ordancewith the policy provisions j <br />Any Auto'I :coverage:i"s not availahfe for this policy, Coverage for Hired Autos only, Scheduled Autos and Non -owned Autos only all apply. <br />CERTIFICNIC HOLDE11 CANCELLATION <br />_.._ ... C a San ia Rrla <br />SHOULD ANY THCABO ESCiiI . OLICIESB£CANCCLLECi13EFt�t3ETHECHnIICATEON ' <br />Risk Management DivWon DATE THE#tEO NOTM 'J€ pC L1Y KuINACCOROANCRMIITiiTHEPOUCYPRiYV3SiflN5 j <br />20 Club Center Plaza 4th rloor � x RIZE Ri-P Nt <br />_...._..._..SANTAANA-._ . __.._ ... .......... .......... — ! <br />;rACORD 25 (n 16/03) i198 =SAd06 CORPORATION -All idights Reserved <br />31'<.17G9 11>t5 The, ACORD n ime and lag.o are registered marks of ¢iCORC3 <br />