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ACORD. CERTIFICA OF LIABILITY INSUI kNCE I PRODUCER (949) 263-0606 FAX (949)263-0906 Complete Znsurance, [nc. Cal'ifornia DO[ #0437762 19000 MacArthur Blvd., Penthouse Floor [rvine, CA 92612-1447 INSURED Albert Grover & Associates 211 E. Imperial Hwy, Ste. 208 Fullerton, CA 92835 COVERAGES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: United States Fidelity &Guar. INSURERS: St. Paul Fire & Marine [ns Co iNSURERC: (C/O St. Paul) INSURER D: INSURER B: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER~OD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANy CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAy HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYI DATE rMM/DD/YYt LIMITS GENERAL LtABILITY BK01479096 07/01/2003 O7/01/2OO4 EACH OCCURRENCE $ 1, O00,000 "~" COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire} $ 500 j 000 ICLAIMS MADE I'--~OCCUR MHD EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 G SNERAL AGGREGATE $ 2 j 000 1000 GNarL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG I $ 2 ~ 000 ~ 000 AUTOMOBILE LIABILITY 3KO1479096 07/01/2003 07/01/2004 COMSINED SING gE LIMIT ANY AUTO (ER accident) 1, OOO, OO0 ALL OWNED AUTOS A SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (PRE accident) -- PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ AUTO ONLY: AGG $ EXCESS LIABILITY ~ ~ EACH OCCURRENCE $ 2,000, OOC OCCUR CLAIMS AGGREGATE $ 2,000, OOC A BK01479096 07/01/2003 07/01/2004 s DEDUCTIBLE RETENTION $ $ WORKERSCOaPENSAT,ONAND ~VA8003695 07/01/2OO3 07/01/2OO4 X ITOBYUMiTS I I°~RH' EMPLOYERS* LIABILITY i B Ai ,'t~OV[.~) ~S TO FOl'~l,, E. L EACH ACCIDENT S 1,000,00(~ E.L DISEASE-EAEMPLOYEE $ 1,000,00(~ _ E L DISEASE - POLICY LIMIT $ 1 ! 000 ~ 00(~ OTHER . 10 day notice applies to , non-payment and/or non- report ing ~DESC~R[P,.TI.ON O.F OPE, RAT_.IO.N EdLOC. A. TION .S/V...RHIC~ES/EXCLD SiON$ ADDED BY ENDORSEMENT/SPECIAL PROVISIO~S er[lrlca~e nolaer is additional insured as respects general hability but only if required by written contract with the named insured prior to an occurence and as per coverage form CL/BF 21810101. Coverage subject to all policy term~ and conditions. CE~ I IFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION City of Santa Aha, its officers, employees, & representatives Public Works Dept. Attn: Dowling Tsai, Trfc Lng Mall Station 43, P.O. Box 1988 Santa Aha, CA 92702-1988 ACORD 25~ {7/97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE rSSUING COMPANY WILL ~O~u~ M Al L 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, i f~va~ Y/J~ ~X~a~1~ fav~ K ~ X~I(X )t K IGXsY~L4~ Xat)CX~ X X X X XX X X AUTHORIZED REPRESENTATIVE A1 icia Igram/MICHMA ©ACORD CORPORATION 1988