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i ~,.~Bar-2~D3 10:23a= From-ROBERT F +g4g-251-1653 <br /> <br /> ROBERT F. DRIVER <br /> License Number= 0C.~6861 <br />Phone (949)756-0271 / Fax (949)7S6-2713 <br /> <br />T-702 <br />T-ESB <br /> <br />P 003/0D3 F-Ol2 <br />P.gO$/llO9 F-154 <br /> <br />Cenlfloa~e Number:Ii7 DM: M12/03 <br /> ~%'~OR / CONTRACTOR LIABILITY PROGRAM <br /> <br />Named Insured: SUSAN J. ATIrJI~ISON <br />AddreSs; 7135 BREIGHTON CIRCLE <br />CitylStat~/Zlp: ORANGE, CA 92g69 <br />Additional Insurcd: CITY OF SANTA ANA <br />Contac~ Term: Fram 11/3/03 To 3/'3/04 <br /> <br />D~scrlption of Contract: CONSULTING <br />Contract Amount $ ! 0,000 <br /> <br />COMMERCIAL GlilN~RAL LIABILITY - NEW OCCURRENCE FORM <br /> <br />Oen~rnJ Aggrcgat~: <br />Products/Completed Opera~ions Limit <br />Personal Advertisin~ <br />Ear~ Oocun'emcc: <br />Fire Damage: <br /> <br />$1,000,OOO. <br />~1,000,000. <br />$1,ooo,000. <br />$1,000,000. <br />$ SO,O00. <br /> <br />IMPORTANT! <br />Cover~es alre Limited xo described co,,~ct. <br /> <br />DEDUCTIBLE: $500. Each Claim. Including Legal and AdjusLmcn! Expenses <br /> <br />ANNU~ PI~r. MIUM: <br />SURPLUS LINES TAX: <br />POIdCY FEE: <br />TOTAL <br /> <br />$500.00 Fully Earned at Inception <br />$15.63 Fully Earned a~ Inception <br />$50.00 Fully Earned ar lncepuon <br /> <br />COMPANY: COLONY NATIONAL INSURANCE COMPANY <br /> <br />THIS COMPANY BINDS THE KIND(S) OF INSURANCE STIPULATED HEREON. THIS <br />INSURANCE IS SUBJI~CT TO THE TERMS, CONDITIONS, AND LIMITATIONS OF THE POLICY <br />OF MASTER POLICY 1~P3073022 ISSUED TO VENDORS/CONTI~CTORS UABLITY GROUP. A <br />COPY OF THIS POLICY IS AVAILABLE ON REQUEST, <br /> <br />THIS CERTIFICATE MAY BE CANCELLED BY TIlE INSURED BY SURRENDER OF THIS <br />BINDER OR BY WRI~ NOTICE TO THE COMPANY STATING V~H'EN CANCELLATION WILL <br />BE EFFEC'IIVE. THIS CERTIFICATE MAY BE CANCELLED BY TIlE COMPANY BY NOTICE TO <br />THE INSURED IN ACCORDANCE WITH TIlE POLICY CONDITIOI~S. <br /> <br />FORM <br /> <br /> <br />