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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) TiM 02/26/2004 PRODUCER (714)836-9945 FAX (714)836-9946 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Empire Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P P HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 555 Parkcenter Drive, Ste 206 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92705-3521 Emily Fisher _ ,-1 V 'E D INSURERS AFFORDING COVERAGE NAIC # 217 North Main Street � j%%4 INSURER B: Suite 300 INSURER Santa Ana, CA 92701 ��Q�, INSURER D'. Y+NF�b 1U` W` INSURER E. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOWATHSTANOIN 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 NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIW DATE MM/DD/yY XPIRATION LIMITS A GENERAL LIABILITY �( COMMERCIAL GENERAL LIABILITY CLAIMS MADE Pil OCCUR 72SBAAD9365 02/12/2004 02/12/2005 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurence $ 300,00 MED EXP (Any one person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 72SBAAD9396 02/12/2004 02/12/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ )( PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR El CLAIMS MADE DEDUCTIBLE RETENTION $ �/�� /� (�l.'j�(�L(a - EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS be. TORV LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL.DISEASE -POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City 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 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Santa Ana *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Planning and Building Agency Ross Annex BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Civic Center Plaza M-20 OF ANY KIND UPON THE IN%UR ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT j Santa Ana, CA 92701 ACORD 25 (2001/08) ©CORD CORPORATION 1988 M