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ID:23am <br /> <br />From-ROBERT F DRI <br />rRut, v-~.g, bnalx <br /> <br />+949-251-1663 <br /> <br /> ROBF..~T F. DRIVER <br /> License Namber: 0C~6861 <br />Phone (949)756-0271 / Fa~ (S~19}766-2713 <br /> <br />T-TOZ <br />T-BSB <br /> <br />P 003/003 F-012 <br />P.O0$/D0g F-154 <br /> <br />Cer~c.~e Number:137 Dam: M12/03 <br /> ~J~}OR I CONTRACTOR LIABILITY PROGI~M <br /> <br />Nnmed Insured: SUSAN J. ATiCINSON <br />AddreSs; 7135 BREIGHTON CIRCLE <br />City/SueTs/Zip: ORANGE, CA 92569 <br />Additional Insured: CITY OF SANTA ANA <br />Conrnc~ Term: From 3~3/03 To 3/3/04 <br /> <br />Dcscrlpfloa of Conlzac~: CONSULTING <br />Contract Amount $10,000 <br /> <br />COMMERCIAL GENRRAL LIABILITY - NEW OCCURRENCE FORM <br /> <br />General Ag~rc§ate: <br />Preducts/Complct~l Operations Limit <br />Personal Advertisi'n§: <br />Each Occurrence: <br />Fire Damage: <br /> <br />~;1,O00,OOO. <br />$1,000,000. <br />$1,000,000. <br />S 1,000,000. <br />$ $0,000. <br /> <br />lrl~ORTANT! <br />Coverages are Limited xo d~scribed co.~cc <br /> <br />DEDUCTIBLE: $500. Each Clnim. lnc. ludin~q L~§nt and AdjuSlmcn! Expenses <br /> <br />ANNUAL PREMIUM: <br />SURPLUS LINES TAX: <br />POLICY FF~E: <br />TOTAL <br /> <br />$500.00 Fully Enmed at lncapdon <br />$15.63 Fully Earned au ~nceprion <br />$50.00 Fully Earned at lncepuon <br /> <br />COMPANY: COLONY NATIONAL INSURANCE COMPANY <br /> <br />THIS COMPANY BINDS THE KiND(S) OF INSURANCE STIPULATED tiEREON. THIS <br />fNSURANCE IS SUBJECT TO THE TERMS. CONDITIONS, AND LIMITATIONS OF THE POLICY <br />OF MASTER POLICY' #CP3073022 ISSUED TO VkNDORS/CONTRACTORS LIABLITY GROUP. A <br />COPY OF TH~S POLICY 1S AVAILAB! ~ ON REQUEST, <br /> <br />THIS CERTIFICATE MAY BE CANCELLED BY TIlE INSURED BY SURRENDER OF TIOS <br />BINDER OR BY WRITTEN NOTICE TO THE COMPANY STAT~NI3 w]-rEN CANCELLATION WILL <br />BE EFFE~. THIS CERTIFICATE MAY BE CANCeLLeD BY ~ COMPANY BY NOTICE TO <br />THE INSURED [N ACCORDA~C~ WITH TH~ POLICY CONDITIONS. <br /> <br />AUTHO~ SIGNATUR.E/C~}~TE RSIGNATU 1~ <br /> <br />FORM <br /> <br /> <br />