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Ae0RD <br />CERTIFICATE OF <br />LIABILITY INSURANC4 CSR JR DATE(MM /DD/YY) <br />POLICY NUMBER <br />DATE NMIDDm <br />OUCH -1 03/16/04 <br />PRODUCER <br />A <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />72 SBA KF4568 <br />01/10/04 <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />The Dougherty <br />Company, Inc. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 7277 <br />MED EXP (Any one person) <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Long Beach CA <br />90807 <br />Phone:562- 424 <br />-1621 Fax:562- 490 -0432 <br />INSURERS AFFORDING COVERAGE <br />INSURED <br />Cti /lJ TC�. <br />INSURER Hartford Insurance Company <br />INSURER B: <br />Touch <br />A ' <br />aoo <br />Vision Inc. N, .3 /[� <br />INSURER C' <br />11095 <br />Knott Avenue <br />01/10/04 <br />INSURER D. <br />Cypress <br />CA 90630 <br />INSURER E: <br />BODILY INJURY <br />(Per person) <br />$ <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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 />ILTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE NMIDDm <br />DATEYMM /DDm N <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE L-L OCCUR <br />72 SBA KF4568 <br />01/10/04 <br />01/10/05 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />FIRE DAMAGE (Any one fire) <br />$300x000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL B ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN L AGGREGATE LIMIT APPLIES PER <br />X POLICY PRO- <br />JECT LOG <br />PRODUCTS - COMP /OP AGO <br />$2,000 000 <br />" <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />72 SBA KF4568 <br />01/10/04 <br />01 /10 /05 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$1,000,000 <br />BODILY INJURY <br />(Per person) <br />$ <br />X <br />BODILY INJURY <br />(Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />GARAGE <br />LIABILITY <br />ANY AUTO <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />AUTO ONLY AGG <br />$ <br />$ <br />A <br />EXCESS LIABILITY <br />X OCCUR CLAIMS MADE <br />DEDUCTIBLE <br />X RETENTION $ SO, 000 <br />72 SBA KF4568 <br />01/10/04 <br />01/10/05 <br />EACH OCCURRENCE <br />$2,000,000 <br />AGGREGATE <br />$2,000000 <br />8 <br />- <br />$ <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />OTHER <br />Hired Auto <br />Ph sical Dama e <br />72 SBA KF4568 <br />01/10/04 <br />01/10/05 <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />.$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT $ <br />Ded $500 50,000 <br />DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />10 days notice of cancellation for nonpayment of premium. Additional insured <br />endorsement attached. <br />rPOTIPIr ATC Ynl non 11 v ........... ... <br />SANTAAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI <br />DATE THEREOF, THE ISSUING INSURER WILL£NBEAYBRip MAIL 30 DAYS WRITTEN <br />City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BtlT- F**iHK *gHSq*B-6Hii <br />Public Works Agency <br />20 Civic Center Plaza, M -43 40 OBERIAf ON <br />P O Box 1988 REPRESEH:ATV . <br />Santa Ana CA 92702 AUTHORIZED REPRESENTATIV <br />25-S(7197) ©ACORD CORPORATInN 1QRR <br />