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<br />
<br /><.
<br />
<br />CERTIFICAT~F INSURANCE
<br />
<br />No
<br />
<br />ISSUE DATE (MM/DOIYY)
<br />9257(j04/02/03
<br />
<br />, ~ At;~.lIIt. .
<br />
<br />VAL56226
<br />
<br />PRODUCER
<br />Barney & Barney,
<br />Barney & Barney,
<br />P.O. Box 85638
<br />San Diego, CA 92186-5638
<br />(858) 457-3414
<br />Mst#: 5564
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
<br />LicOC03950 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS CERTIFICATE
<br />L. OC24310 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
<br />~ C POLICIES BELOW.
<br />COMPANIES AFFORDING COVERAGE
<br />--- --- --
<br />HARTFORD-HARTFORD FIRE INSURANCE CO
<br />
<br />LLC-CA
<br />Inc-CA
<br />
<br />f~~~~NY A
<br />
<br />TRAVELERS-TRAVELERS INDEMNITY CO
<br />
<br />";;SURËD~VALLEY 'DETROI TDiESEL~ALLISON f~~~NY B
<br />(A CORP)., ETAL, SEE ATTACHED
<br />
<br />425 S. HACIENDA BOULEVARD
<br />
<br />CITY OF INDUSTRY
<br />
<br />CA 91745
<br />
<br />f~~~~NY C
<br />
<br />MONTLAKE CASUALTY CO - ACE AMERICAN
<br />INSURANCE COMPANY.. , " ..... . .....
<br />NO COVERAGE ON THIS DOCUMENT
<br />
<br />f~::~~NY D
<br />
<br />f~~~~NY E
<br />
<br />NO COVERAGE ON THIS DOCUMENT
<br />
<br />-------------
<br />
<br />COVERAGES
<br />
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
<br />BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND
<br />CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />-~~--~ TYPE ~F INSURANCE I POLICY NUMBER---~.~--'.r;gk~~J~'~ig~-;r;g~~~i~b~m~~--~. .
<br />I
<br />
<br />! GENERAl.. LIABILITY
<br />[------,
<br />¡X! COMMERCIAL GENERAL LIABILITY
<br />Ar,=_-t-J CLAIMS MADELxJ OCCUR.
<br />L____) OWNER'S & CONTRACTOR'S PROT.
<br />i 1--.-----------.-
<br />
<br />, AUTOMOBILE LIABILITY
<br />~--._---.
<br />:__x-J ANY AUTO
<br />i I ALL OWNED AUTOS
<br />~------l
<br />l~j SCHEDULED AUTOS
<br />B1 I HIRED AUTOS
<br />------1
<br />L._--J NON-OWNED AUTOS
<br />L._J GARAGE LIABILITY
<br />! i
<br />~.?'_CESS LIABILITY
<br />! l UMBRELLA FORM
<br />r-~.--l OTHER THAN UMBRELLA FORM
<br />
<br />I
<br />C,
<br />
<br />WORKER'S COMPENSATION
<br />AND
<br />EMPLOYERS' LIABILITY
<br />
<br />: OTHER
<br />
<br />nCESOA1988
<br />
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />i
<br />I 810525D5839
<br />
<br />I
<br />
<br />
<br />I NO COVERAGE
<br />
<br />
<br />I C4346822
<br />I
<br />
<br />LIMITS
<br />
<br />l GENERAL AGGREGATE -li$..~_2_I_O_OO,O ° 0
<br />! ;RODU~~-~~C-~;:;~;~~-;~~:- ---f-~..~2 .,_0..0.0., 0 ° 01
<br />04/01/04,P'RSONAL&ADVINJURY. .(1$*_1,000, 000
<br />;EACHOCC_URR,'NC'. . m $.':1,000, 0001
<br />i_FI_~~_[)~~~::>_~J~~_.o~e_f!_re)__------i-$-~_~_~3_D.o, 00 o¡
<br />! MED. EXPENSE (Anyone person): $ * * * * ;
<br />
<br />04/01/03
<br />
<br />
<br />COMBINED SINGLE
<br />LIMIT
<br />
<br />BODILY INJURY
<br />(PerperSQn)
<br />
<br />04/01/03 04/01/
<br />
<br />BODILY INJURY
<br />(Per accident)
<br />
<br />PROPERTY DAMAGE
<br />
<br />; ~CH 9~CU_R_f3~!'J~~ -
<br />tA~G~E~AT_E --
<br />
<br />04/01/03,
<br />
<br />X_--,-_S!~" "lJTO~'r'--~IM.IT~ .
<br />04/01/04EACHACCID'NT m .
<br />! DI~~SE - P_Oll~Y_Ll~~T.-
<br />DISEASE - EACH EMPLOYEE
<br />
<br />NO COVERAGE APPROVED AS TO FORM
<br />
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I SPECIAl.. ITEMS
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CITY OF SANTA ANA, ITS OFFICERS,
<br />AGENTS, EMPLOYEES AND
<br />REPRESENTATIVES; P.O. BOX 1988
<br />20 CIVIC CENTER PLAZA M11
<br />SANTA ANA CA 92702
<br />
<br />ACORD 25-5 7/90
<br />
<br />Eaura Sh:>_ò
<br />D,eputy City Attorne)'
<br />
<br />, -
<br />..*.1,.000, 000'
<br />
<br />$*********0
<br />
<br />$ * ********0:
<br />I
<br />$*********
<br />, I
<br />-} ~-_?:_~_*:_~-~_'!'_-Jr* * 01
<br />.J_~_1:...'!'._~-~_'!:_~--1:.* * 0
<br />I
<br />i
<br />I
<br />.1. .. I
<br />.¡I$ *1,00 Q , 0001
<br />$*1 000 000
<br />-,---------,------, I
<br />: $ *
<br />1
<br />
<br />......
<br /><=
<br /><=
<br />~
<br />
<br />=En
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<br /><02:
<br />rrl3:~
<br />
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<br />
<br />Þ
<br />CANCELLATION ~-
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCELLE~ORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING COMPAN'('ïNILL X~~~X9C
<br /><XI
<br />MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
<br />LEFT, 'M.:X*I)rn\ï:X'XM*!(~)fflJì!m<::mH!,:x!M'1rnK1!!Ç;JQ~Jì!m<:R'X
<br />L~K'P:!~JfK~~!{mÐrnM~XxrKX~~IJflì.ID!R'Jì!J@'IX
<br />
<br />
<br />AUTHORIZ' R R S'N~¡~ ~\ìJ
<br />
<br />THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER THE ATTACH D ENDORSEMENT.
<br />
<br />CACORD CORPORATION 1990
<br />
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