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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T7M 1 02/26/2004 PRODUCER (714)836-9945 FAX (714)836-9946 The Empire Company THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR S55 Parkcenter Drive, Ste 206 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92705-3521 Emily Fisher D INSURERS AFFORDING COVERAGE NAIC# INSURED Rosenow Spevacek Group, IncR INSURERk Hartford Insurance 217 North Main Street ry �ap4 Suite 300 R INSURER B. INSURER Santa Ana, CA 92701� [ INSURERD: YL7NT1��G��_ M1�T INSURER E'. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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 D NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMMD/YY POLICY EXPIRATION DATE MMIDD/YV LIMITS GENERAL LIABILITY 72SBAAD9365 02/12/2004 02/12/2005 EACHOCCURRENCE $ 11000,00 PREMISES Ea occurence $ 300,00 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OOCCUR MED EXP(My one parson) $ 10,00 PERSONAL BADVINJURY $ 1,000,00 A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECTPRO LOC AUTOMOBILE LIABILITY ANY AUTO 72SBAAD9396 02/12/2004 02/12/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000 00 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY'. qGG $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE.[/ % EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE - $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEP/EXECUTIVE TORYLIMITS ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? nder If yes describePRO ISIO SPECIAL PROVISIONS below E. L. DISEASE -EA EMPLOYE $ E. L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ity of Santa Ana, its officers, agents, employees, volunteers and representatives are named as additional insureds. *10 day notice of cancellation shall apply for non-payment of premium. CERTIFICATE HOLDER City of Santa Ana Planning and Building Agency Ross Annex 20 Civic Center Plaza M-20 Santa Ana, CA 92701 25 (2001108) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL rt30_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 114UR§R ITS AGENTS OR REPRESENTATIVES. 1988