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AC&_D CERTIFICA*OF LIABILITY INSURANSOP ID $ DATE(MMIDD/YYYY) KENJR-1 09/30/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Corona Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 789 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Corona CA 91718 Phone:909-737-2270 Fax:909-735-2755 INSURERS AFFORDING COVERAGE NAIC0 INSURED INSURER A: Royal Surplus Linea Ina CO INSURER B: Mercury Insurance Group 27553 KEN THOMPSON, INC. A-,AO03-t758 INSURER C: Royal Insurance Co of Aaerica Ms. Lisa Parry P.O. Box 77640 Corona, CA 92877-0121 INSURER D: State Compensation Fund INSURER E: Trawlers Pro,arty caeualt 02/13/03 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR K2RA122245 02/13/03 02/13/04 PREMISES (Ea occuranw) $50,000 MED EXP (Any one person) $ EXCLUDED X Owner/Cont Prot. PERSONAL R ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO 52,000,000 POLICY X PRO- JECT OC B AUTOMOBILE X LIABILITY ANY AUTO AC11057267 02/13/03 02/13/04 COMBINED SINGLE LIMIT $ 1 000 000 (ea accident) , , ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) X X HIREDAUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) X **Any Auto See PROPERTYDAMAGE (Per acddent) $ below GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ AUTO ONLY: AGG $ ANY AUTO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 C X OCCUR FICLAIMSMADE P2HA208823 04/23/03 02/13/04 AGGREGATE $5,000,000 E $ DEDUCTIBLE $ RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS LIABILITY PROPRIETOR/ RIEXECUTIVE 6653020-03 06/30/03 06/30/04 X TORY LIMIT$ LR E.L. EACH ACCIDENT $1 000 000 r , E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFtCEANY EXCLUDED? Ves,R/MEand EXCLUDED? Byes, ALPRdescribe under SPECIAL PROVISIONS GeIow E. L. DISEASE -POLICY LIMIT E1,000,000 OTHER B Physical Damage AC11057267 02/13/03 02/13/04 Comp/Coll 1,000/1,000 E Rented Equipment 660153D9507 1 02/13/03 02/13/04 1,000 Ded 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re:On-call Agreement. The City, its officers, employees, agents, volunteers & representatives are named as additional insured per the attached endorsement.**This coverage is for the benefit of the Certificate holder only. *10 days notice of cancellation for non-payment of premium. sANTAAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT[01 DATE THEREOF, THE ISSUING INSURER WILL END EAVO L *30 DAYS WRITTEN Ai'I`1iOVZ li AS 1'0 I U. NICE TO THE CE GA OL NAMED TOT E LEFT, BUT F LURE TO DO SO SHALL City of Santa Ana IMPOSE NO OBLI ATIONO LIA ILITY 'ANY KIN UPON NSURER ITS AGENTS OR P.O. Box 1988 Santa Ana, CA 92702 REPRESENTATIVES. I_a H . iot,d, f -AUIHQMZED REPIkNT` IA 1988