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'ACORD.. CERTIFICATE OF LIABILITY INSURANCE <br /> <br />DATE (MM~DD~FYYY) <br /> 04/16/2003 <br /> <br />PRODUCER <br /> AT.I. AGENCY, INC. <br /> 1022 N.E. 65TH ST. <br /> SEATTLE, WA 98115 <br /> <br />INSURED <br /> <br />THE PACIFIC INSTITUTE, INC. <br />P.O. BOX 84208 <br />SEATTLE, WA 98124 <br /> <br />206-522-9200 <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 />INSURERS AFFORDING COVERAGE <br /> <br />INSURERA: AMERICAN STATES INSURANCE CO. <br /> <br />INSURER B: <br />INSURER C: <br />INSURER D: <br /> <br />NAIC # <br /> <br /> INSURER E: <br /> <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH 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 /> POLICY EFFECTIVE POLICY EXPIRATION <br /> POLICY N UMBER DATE tMM/DD/YY} DATE fMMIDD/YYI LIMITS <br /> <br />GENERAL LIABILITY <br /> <br /> COMMERCIAL GENERAL LIABILITY <br />__ CLAIMS MADE L~J OCCUR <br /> <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br /> <br />AUTOMOBILE LIABILITY <br /> <br /> ANYAUTO <br /> <br /> ALL OWNED AUTOS <br /> <br /> SCHEDULED AUTOS <br /> <br /> HIRED AUTOS <br /> <br /> NON)OWNED AUTOS <br /> <br />02-CC-202232-3 <br /> <br />02/04/03 <br /> <br />02/04/04 <br /> <br />EACH OCCURRENCE $ <br /> <br />GARAGEL~BILITY <br /> ANY AUTO <br /> <br />PREMISES (Ea occurence.) <br />MEO FXP (Any one person) <br /> <br />1,000,000 <br /> 200,000 <br /> <br />.$ 10~000 <br />$ 1,000,000 <br /> <br />EXCESS/UMBRELLA LIABILITY <br /> OCCUR I I CLAIMS MADE <br /> <br />DEDUCTIBLE <br />RETENTION $10,000 <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY P ROPRIETO PJPARTN ERJEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />tf yes, describe under <br />SPECIAL PROVISIONS below <br /> <br />OTHER <br /> <br />02-CC-202232-3 <br /> <br />01-SU-102425-30 <br /> <br />02/04/03 <br /> <br />02/04/03 <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. <br /> <br />02/04/04 <br /> <br />02~04~04 <br /> <br />PERSONAL & ADV INJURY <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS ) COM P/DP AGG <br /> <br />PROPERTY DAMAGE <br />(Per accident) <br /> <br />$ 2,000,000 <br /> <br />COM DINED SINGLE LIMIT 1,000,000 <br />(Ea accident) $ <br /> <br />BODILY INJURY <br />(Per person) $ <br /> <br />BODILYINJURY <br />(Per accident) $ <br /> <br /> $ <br /> <br />AUTO ONLY ) EA ACCIDENT <br /> <br />OTHER THAN EA ACC <br />AUTO ONLY: AGG <br /> <br />EACH OCCURRENCE <br /> <br />AGGREGATE <br /> <br />X j wc STATU) IOTH) <br />ITORYLIM TS ER <br /> <br />E.L. EACH ACCIDENT <br /> <br />E.L. DISEASE)EAEMPLOYEE <br /> <br />E.L. DISEASE ) POLICY LIMIT <br /> <br />F)¢putv City Attorney <br /> <br />10,000,000 <br /> <br />10,000,000 <br /> <br />$ 1,000,000 <br /> <br />$ 1,000,000 <br />$ 2,000,000 <br /> <br />FORM <br /> <br />CERTIFICATE HOLDER CANCELLATION <br /> <br /> CiTY OF SANTA ANA <br /> ATTN: ANNABELLE BATES <br /> 1000 E. SANTA ANA BLVD., SUITE 220 <br /> SANTA ANA, CA 92702 <br /> <br /> I <br />ACORD 25 (2001/08) <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ~J~t'~'~[~Or-.MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br /> <br />' ~ f' ~~~ 'ACORD CORPO~TION 1988 <br /> <br /> <br />