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ACORD, CERTIFICATE OF LIABILITY INSUI KNCE <br /> <br />DATE (MM/OD/YY} <br />07/07/2003 <br /> <br />PRODUCER (949) 263-0606 FAX (949)263-0906 <br /> Complete Insurance, Inc. <br /> California DO[ #0437762 <br /> 19000 MacArthur Blvd., Penthouse Floor <br /> Irvine, CA 92612-1447 <br /> <br />INSU~[ED <br /> <br />Albert Grover & Associates <br />211 E. Imperial Hwy Ste. 208 <br />Fullerton, CA 92835 <br /> <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />COVERAGES <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />INSURERB: (C/O XL Insurance) <br /> <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD iNDICATED. NOTVVlTHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU/v~NT W~TH RESPECT TO WHICH THIS CERTIFICATE MAy BE 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 /> <br /> INSR pOLiCY EFFECTIVE POLICy EXPIRATION <br /> LTR TYPE OF INSURANCE POLICY NUMEER DATE t MMID0/YY) DATE t MM/DD.rYYt LIMITS <br /> GENERAL LIABILITY -:ACH OCCURRENCE <br /> <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) <br /> I OCCUR [] CLAIMS MACE ,GGREGATE $ <br /> <br /> om . ~'£C001~19701 07/09/200t !07/0~/2004 $2,000,000 Per Claim <br /> )ro~essaonal Liabl] ity <br /> A $2,000,000 Aggregate <br /> <br />30 day notice Endt. ENSVSE165 included - 10 day notice apphes to ~_~..~D AS TO FORM <br /> <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION <br /> <br />City of Santa Aha, its officers, employees, & <br />representatives <br />Publlc Works Dept. <br />Attn: Dow]ing Tsal, Trfc Eng <br />Mail Station 43, P.O. Box 1988 <br />Santa Aha, CA 92702-1988 <br /> <br />ACORD 28-S (7/$7) <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> <br />EXPIRATION DATE~HEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LBFT, <br /> <br />BUT FAll. LIRE TO MAIL SUCH NOTICE SHALL iMPOSE NO OBLIGATION OR LIABILITY <br /> <br />OF ANY KiND UPON THE COMPANY, ETB AGENTS OR REPRESENTATIVES. <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />A] icia I~Iram/MICHMA <br /> <br />©ACORD CORPORATION 1988 <br /> <br /> <br />