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<br />Jun 06 05 1112Bl!l
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<br />Re-.ever
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<br />1905)
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<br />~)J~
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<br />~ Page I of 1
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<br />Certificate of Insurance
<br />S~-_.- n'''gram
<br />'Y~~"" .J.-,v
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<br />A- d-C03-180
<br />A- .J.CO+- :A\(o
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<br />NArtlild Additional Jnsur~d:
<br />SANTA ANA (SPARTA)
<br />20 Civic Center PI.,." PO Box 1988
<br />SUOl" Anu CA 92701
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<br />Name In~urc<1:
<br />Adlernorst lmerni\\ional, \I)C,
<br />3951 Vernon Ayo
<br />Riverside, CA 925\\9
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<br />Certificate If
<br />Covcrngc
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<br />Limits
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<br />O('ductiblc.
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<br />Tcrm:ll &
<br />Conditions
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<br />F:~du~ions
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<br />302 W, Ccrrii '.:-
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<br />SSAH4..(II)30
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<br />s )^Wi:\ n,;~~( 1/~"'~(-;:', ~'.r{I)C{'\, ...-::: C'~JnJ:r.';;:I'c:n~ G.II~I'i,; LI~bi:ity ~ :'~l..l.h(U J
<br />Con~1',.cr \,'1'."1.'.: 1) i ,~,O(<~.(jO
<br />L::)\IV:i!.!.C 1) 'r:;)(} 5i:, I :'?(.;)5 '.:. ~ '3 ~ 1:'J()i)
<br />InslF,~(_l!n: rl'J.ni~':- f;..~;I:~; :t!~;U".:w.,~,:{(mfl'1I\Y
<br />1V.i~L'h~r Pelky' 3('~11'j"r7;
<br />Mas~.';r p(:I:C;: ['-il..... :/i..,: :1~k i i ii ~,(:i)\:4 \." :.,'l.\<'.'til"l:
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<br />.
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<br />$:~.Q()nJ00~'" (i,.'m.~;'l\: .\tl.:;r:~gi1.t,j " $I,U::C.;/):). 1~ad1 (j~Clirl\~:'.C:;; / J,1.~00,(;00 pj'0J\..~t.)/Ccmpl{;H;i.i of.'~l'ations
<br />$I,ll:iG.~C:~ P.:rsonal & Advcrti!\ing Injury/$SO,OOO Fire l)~m\'ge I M~dical Pflyrn~nts ExCIUl.ktl
<br />
<br />'E5n~j 8i & pro; fi..::r tialman' including LOR~ ^djll~tment Expense
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<br />:;"5,),00 Premium (Full)' Earned)
<br />;'2':. :1 ';",;.',C"; (pwlly Earm;d)
<br />$7:1,00 Certltic,th: ";". '; :'':'lllly Earned)
<br />
<br />~J4'}.1'.1
<br />
<br />I'otal Amount
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<br />l. '!'Jo C:.r.~.;!:..::c.;:5 f\~:c'.;:cd. ?r~m;um, ljt....c~ ilOO 1~l.'1'i urc i'uiiy camcd ar inceptloll.
<br />2. O!)~r!ltjoll~ n..'1d R:H,illr;. Dvsed: Tral,ilr.g {(~9 & pol:u.:: oi'Jic(;fS \);i I..:ity property. (No public ~xpasurcl.
<br />:. i)jI,r.I,.,"in'.;:~nr: ~lt)!l! .~ll::! !JC)::,;~ :...."Ie~~:t~c:':t
<br />oJ. ^,~rjlti(..;,11 :;',<;'I.ih~d(Ill): Not AppHc~bk:
<br />5. No ProfO!lsion;1ll..iability Coverage proyidcd.
<br />!>. ~O ?IJIlI.:C F.X?OSt;RG WORKING WITHIN THE CITY OF LOS ANGELES PEPAI{l'MENT, Al\D
<br />THEIR F.MPLOYFF.S ONI ,Y,
<br />o N0 COVERA"F. PROVIDED EOR ANIMAL MORTALITY OR DOG BITES.
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<br />,\.;'....~:,U)::, .I\ssl.:lult & Ratl:C:1Y, Employer Related Practices, Sub~idl:nl.:l:, Independent Contr~ctol's. Polhnioll. Cro:\.'i
<br />~L;t, Lc.:;.u (;1' Si.'I~1i Dust, Mold or Bio-orgnnic Oro\'{1"11 or MlJd.::w, PUnilivl: Damage...., ^nima.l. F.lr~ach orColltnt(;l,
<br />Y2K E!l:ctn:,nir D:mt \l!c?i<:ul Pnynle~ts, WOI'orlerrorlsrn.
<br />The insurancc provided undo!' this policy Is limited to your work pl.:rlurmcd on bch~lf of the entity J).ln1cd il.'i
<br />"Additional NWT1Cd Insured" above and doesn't eX1cnd itsclr 10 nny other work pcrrom'\cd by you or your
<br />organj~lion. Cuverage is limited t(l the des.cription of opertlt-ions and rating ba.sr..'~ li~llXl in .ITCfIllS & Cor,ditlon.~"
<br />ilem2,
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<br />Pel' the Master polic~', a copy is ~vailu.blc by \>"'ritten request' tp: \tfunicip~lity InsurMC-': Sl.:ryiccs, Inc.; 302 \V,
<br />Cerrito, Ave.. l3ullding li7. Anaheim, CA 9"805
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<br />t'(,.li~M
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<br />~~-
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<br />APPROV[
<br />,t>fl L/k./;:./.."....,...._
<br />;"-':',', ."'~' -" ..,.~~~ '!D)'
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<br />Ci1r()1 Frost, I PI'C$id~nt
<br />Municipaliry rn~u:'ancc: Services, Inc.
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<br />/"..,0"
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<br />,,,,,h .....il) Ali()Cncy,
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<br />Jr~'''''';'l_.,,'''''~1X-i~.._~. ,_
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<br />""~,' 7 Anaheim, CA 92805 (800) ";':>')-j5' (7'.J! (r~7 ! 1 ('(\ fux (7) 4) 6R7.11 06 l.iCClm'CA:OC048.1~; OR: 195423
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