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Complete Insurance <br />10/30/2003 11:55 PAGE 002/003 Fax Server <br />CO , CERTIFICATE OF LIABILITY INSURANCE <br />1oi22/20 " <br />PRODUCER (949)263 -0606 FAX (949)263 -0906 <br />Complete Insurance, Inc. <br />California OOI #0437762 <br />19000 MacArthur Blvd., PH Flr <br />Irvine, CA 92612 -1447 <br />THIS CERTIFICATE IS ISSUED ASA 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 <br />NAICm <br />INsUREo Caribou Industries <br />1200 North Main Street <br />Suite 900 <br />Santa Ana, CA 92701 <br />INSURER Fireman's Fund Insurance Co <br />POLIG'I EFFECTIVE <br />INSURER B: <br />UMITS <br />INSURER C. <br />- <br />NSURERm <br />MZX80812132 <br />INSURER E <br />04/14/2004 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NDTWITHSTANDIN <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 />INSR <br />LTR <br />D' <br />TIPE OFINSURANCE <br />POLICY NUMBER <br />POLIG'I EFFECTIVE <br />POLICY EXPIRATICN <br />UMITS <br />GENERAL UABLITY <br />MZX80812132 <br />04/14/2003 <br />04/14/2004 <br />EACH OCCURRENCE <br />s 1, ODD, DD <br />X GCMMERCIAL GENERAL LIPBLITY <br />CAMAGe 0 T <br />3 100,000 <br />0..VMBMADE a0CCUR <br />MSD EpP (Any ana Persa+l <br />f 5, DOC <br />A <br />PERSONAL AADVIWURY <br />f 1,000,000 <br />GENERAL AGGREGATE <br />f 2,000,00 <br />GENL AGGREGATE LIMIT APPUESP_m <br />X POLICY jga MLOC <br />PRODUCTS. OCMPIOP AGG <br />f 2,000,000 <br />AUIOMOSILE <br />LIASLIrY <br />PINY AUTO <br />MZX80812132 <br />04/14/2003 <br />04/14/2004 <br />COMBINED SNGLELIMIT <br />(Ea emaenV <br />f <br />1,000,000 <br />BODILY INJURY <br />(pet pe'.o <br />f <br />A <br />X <br />X <br />ALL ONMEO AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OMED ALTOS <br />BODILY IWURY <br />(Peracciben) <br />f <br />PRCPVTY DAMAGE <br />(Per ambN¢I <br />f <br />GARAGE UABIUW <br />AUTO ONLY - EAACGOENT <br />S <br />ANY AUTO <br />EA ACC <br />HAN <br />f <br />AUTO O <br />AUTO ONLY: pGG <br />S <br />EXCEASSWBRELLA UASLnY <br />XYZ00085551612 <br />04/14/2003 <br />04/14/2004 <br />EACH OCCURRENCE <br />S 10,000,00 <br />7 X OCCUR D0.APASMADE <br />AGGREGATE <br />$ 10,000,000 <br />A <br />f <br />f <br />omurna.E <br />RSTENTCN 3 <br />f <br />YORKERS COMFE]MAPON AND <br />WC ATU• H4 <br />EMPLOYERS'UASL <br />ANVCSRJM ETORIPARTNERIEXECUnVE <br />EL. FACH ACCIDENT <br />3 <br />E.L. DISEASE -6A eNFLOY <br />f <br />OFMCERANEMBER E:0. VOED? <br />If yes, dewwu ft' <br />SPECIAL PROMV0?4S bel. <br />E.L. DISEASE - POLICY LIMIT <br />I $ <br />OTHER <br />OESC$ PTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENOORSEMENT /SPECIAL PROVISIONS <br />e: Walnut & Sycamore, Santa Ana, CA. <br />he certiicate holder is included as an additional insured per attached Exhibit "B" - Additional <br />nsured Endorsement for Commercial General Liability Policy. <br />10 day notice of Cancellation for non - payment of premium. <br />City of Santa Ana <br />20 Civic Center Plaza (M -25) <br />Santa Ana, CA 92701 <br />ACORD 25 (20011M) <br />SHOULD ANY OF THE ABOVE DESCRIBED FOLICIIef SE CANCELLED BEFORE THE <br />EXPMATION DATETHEREOF, THEISSUING INSURERWILL 'Xwdit MAIL <br />- DAYSWNI^ ENNOTICETOTHECSRTMUWMWMNAMEDTOTHELF .. <br />AS <br />City Attorney <br />H.&S:Ino." <br />(VACORD CORPORATION 1958 <br />