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Client#: 29955 <br />DOTYBRO <br />ACORDTM CERTIFICATE OF LIABILITY <br />INSURANCE <br />010„04°"Y"' <br />PRODUCER <br />USI of Southern California <br />Lic# 0351162 *** 818 971-5422(Suzan) <br />PO Box 9004 <br />Van Nuys, CA 91409 <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 />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />Doty Bros. Equipment Co. <br />11232 E. Firestone Blvd. <br />Norwalk, CA 90650 <br />-( <br />��QO� — /`15 <br />INSURERA: American Int'I Spec. Line AIG <br />INSURER B: National Union Fire <br />INSURER c: American Home Assurance <br />INsuRERD: Zurich/American Ins. Grup <br />INSURER E: Arch Spec. Ins. Co. <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 />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MMFECTIV <br />POLICY EXPIRATION <br />DATE(IiiPIRATI <br />LIMITS <br />A <br />GENERAL LIABILITY <br />GL9332880 <br />10/11/03 <br />10/11/04 <br />EACH OCCURRENCE $1000000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTEDPREMISES Ea o u $50 ,000 <br />CLAIMS MADE 51OCCUR <br />MED EXP (Any one person) $5,000 <br />PERSONAL&ADV INJURY $1000000 <br />x BFPD/XCU <br />x Contractual <br />GENERAL AGGREGATE s2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />POLICY X PRO LOC <br />JECT <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />CA8261523 <br />10/11/03 <br />10/11/04 <br />COMBINED SINGLE LIMIT <br />(Ea accident) $1,000,000 <br />X <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />- <br />BODILY INJURY $ <br />(Per person) <br />X <br />X <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />/ <br />/ <br />1 <br />BODILY INJURY <br />(Per accident) $ <br />X <br />Comp $1000 <br />((( <br />PROPERTY DAMAGE $ <br />Per accident) <br />X <br />60-11 $1000 <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EAACC $ <br />ANY AUTO <br />AUTO ONLY: AGG $ <br />E <br />EXCESS/UMBRELLA LIABILITY <br />X1 OCCUR F—I CLAIMS MADE <br />72ULP1270001 <br />10/11/03 <br />10/11/04 <br />EACH OCCURRENCE $10000000 <br />AGGREGATE $10,000,000 <br />$ <br />$ <br />DEDUCTIBLE <br />- $ <br />X RETENTION $10,000 <br />C <br />WORKERS COMPENSATION AND <br />WC6435957 <br />10/11/03 <br />10/11/04 <br />WCSTATU- 01 <br />X I 13 H - <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />EL. EACH ACCIDENT ' $1,000,000 <br />E.L. DISEASEEAEMPLOYE $1,000,000 <br />OFFICERIMEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT $1,000,000 <br />D <br />OTHER Equipment <br />MCP455064201 <br />10/11/03 <br />10/11/04 <br />$500,000/$10,000 Ded <br />Leased/Rented <br />A jPollutlon <br />CP01178150 <br />10/11/03 <br />10/11/04 1 <br />$5,000,000 $10,000 Ded <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*Except 10 Days non -pay <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE <br />ADDITIONAL INSUREDS AS EVIDENCED BY ATTACHED ENDORSEMENT. <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />ACORD 25 (2001/08) 1 of 2 flM2D27N17 <br />ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />THEREOF, THE ISSUING INSURER WILL x nIRMMAIL *an DAYSWRITTEN <br />CERTIFICATE HOLDER NAMED TO THE LEFT <br />AUTHORIZED REPRESENTATIVE <br />�3HU:UIH�7:7 Z�7:LU P7: iEI i'. <br />