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~--M~r-2~O3 lO:Z3am <br /> <br />FrorROBERT F <br /> <br />+849-251-1663 <br />a4U-(ZZ-41TZ <br /> <br /> ROBERT F. DRIVER <br /> License Number: 0C~6861 <br />Phone (949)756-0271 / F~ (949)756-2713 <br /> <br />%?02 <br />T-ESB <br /> <br />P 003/003 F-OI2 <br /> P. 005/000 F-i 54 <br /> /'1"-6 Z_ - d 4 <br /> <br />Certificate Number:137 Da~e: 3/12/03 <br /> ~N~OR / CONTRACTOR LIABILITY PROGRAM <br /> <br />Nnmed lnsur~k SUSAN J. ATKINSON <br />AddreSs: 7135 BKEIG~-FFON CIRCLE <br />CitylSmm/Zlp: ORANGE, CA 92869 <br />Additional Insured: CITY OF SANTA ANA <br />Contact Term: From 3/3/03 To 3/3/04 <br /> <br />Description of Conuract: CONSULTING <br />Contract Amount: $10.000 <br /> <br />COMMERCIAL G]gNRRAL LIABILITY - NEW OCCURRENCE FORM <br /> <br />General Aggregate: <br />Produc~s~Complewd Operations Limit <br />Pe~onal Advertisi.§: <br />Eaah Oc, cm'tence: <br />Fire Damage: <br /> <br />$1,000,000. <br />$1,000,000. <br />$1,000,000. <br />$1,000,000. <br />$ $o,000. <br /> <br />IMPORTANT! <br />Coverages a~e Limited ~o described con~-~ct <br /> <br />DEDUCTIBLE: $500. Each Claim. Including Legal and Adjustmen! Expenses <br /> <br />ANNUAL PREMIUM: <br />SURPLUS LINES TAX: <br />POLICY FEE: <br />TOTAL <br /> <br />S500.00 Fully Famed at Inc~p:ion <br />S15.63 Fully Em'ned at l. nceprion <br />$50.00 Fully Earned at Inception <br />SS6~,~ <br /> <br />COMPANY: COLONY NATIONAL rNSUR. ANCE COMPAN'Y <br /> <br />THIS COMPANY BINDS THE KIND(S) OF INSURANCE STIPULATED ItEREON. THIS <br />INSURANCE IS SUBIECT TO THE TERMS, CONDITIONS, AND LIMITATIONS OF THE POLICY <br />OF MASTER POLICY #CP3073022 ISSUED TO VENDORS/CONTRACTORS LIABLITY GROUP. A <br />COPY OF THIS POLICY IS AYAILABLI~ ON REQUEST, <br /> <br />THIS CERTIFICATE MAY BE CANCELLED BY THE INSURED BY SURRENDER OF TI-IlS <br />BINDER OR BY WRITTEN NOTICE TO THE COMPANY STATING WHEN CANCELLATION WILL <br />BE EFFECTIVE. THIS CERTIFICATE MAY BE CANCELLED BY TIIE COMPANY BY NOTICE TO <br />THE INSURED IN ACCORDANCE WITH THE POLICY CONDITIONS. <br /> <br />ALITHO~ SIGNATUR~CO~TERSIGNA~UI~ <br /> <br />R_E. CI-~D( & ASSOCIATES INSURANCE BROKERS .INC. <br />Lic~M Numbe~. 07Z~213 <br />IS01 W~iffD~ Sukc 290, N~p~ B~eh. CA g2~0 <br />PHONE (~)~1~ I ~: ~949)722~172 <br /> <br />APPROVEI) AS TO <br /> <br />~aura Shecd~ 1'7 <br />l)eputv City Attorney <br /> <br />FORM <br /> <br /> <br />