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<br />0211:10.12004 11: 06 FAX 7607402052 <br />.~-- <br /> <br />DRIVER/HOSPITALITY <br /> <br />I4J 002 <br /> <br />CERTIFICATE OF LIABILITY INSURANCE I DATE {MM/OD!YYYY} <br /> 02/12/2004 <br />P~OOUCER THIS CERTIf'ICATE IS ISSUED AS A MATTER OF INFORMATION <br />BURNS /I WILCOX INSURANCE SERVICES, INC_ ONLY AND CONFERS NO RIGHTS UPDN THE CERTIACATE <br />2650 CAMINO DEL RIO NORTH, SUITE 308 HOLDER THIS CERTIFICATE DOES NDT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFOROED SY THE POLICIES BELOW. <br />SAN DIEGO. CA 92108 COMPANIES AFFORDING COVERAGE <br /> COMFI"NY <br />CA '.31 aB4-DRIR03-910800-PRO A COLONY INSURANCE COMPANY <br />INS U~EO COMPANY <br />THE MATTMAN COMPANY B <br />1004 RANCHEROS DRIVE l;QMPANy <br />SAN MARCOS. CA 92069 C <br /> COMPANY <br /> D <br />COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF IN$URANCE LISrED BELOW HAVE BEeN ISSUED TO THE INSUReD NAMEP ABOVE FOR THE POLICY PERIOD <br /> IND1CATEO. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR QTH!:R DOCUMENT WITH RESPECT 10 WHICH nits <br /> CERTIFICATe: MAY BE ISsuE:D OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICieS OESCRlljlliD HEREIN IS SUBJECT '1'0 ALL THE TERMS, <br /> EXCLUSIONS ANCl CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MA.Y HAVe BEtiN REDUceo BY PAlO ClAIMS. <br />CO 1'1'P'E. OF lJII$uRAl\lCE FOUCV NU"'BEfl Pg;~i~:~~~i; P~l;'~ .EX"'IRA!.~N LlMrrs <br />LT" CIA TE fMMfCDh'Y) <br /> GENERAL L1AaIUTY GeNERAL AGGREGATEi . 2 000.000 <br /> i ~OMM"RCIAL GENERAL LIABILITY PRooUCTS-COMP!QP AGG $ 2,000.000 . <br />A ~, QAIMS MADE [KJ OCCUR. GL 152084 01/17/2004 01/17/2005 PERSONAL &MJV INJURY . 1 000.000 <br /> :!!!Z OWNeRS &. CONTRACTORS pROT, EACH OCCURReNCE $ 1,000.000 <br /> - 100,000 <br /> - FIRE DAMAGE (Any on/il fire) $ <br /> ME.O EXP (Anyone parson) . 5.000 <br /> ~UTOM081U: UASIUTY COMBINED SINGLE LIMIT $ <br /> N-lYAUTO <br /> ALL OWNED AUTOS BOOIL Y INJURY $ <br /> - SCHEDULEO AUTOS (Perpe:n;on) <br /> HIRED AUTOS . BOOILY INJUR.Y $ <br /> - NON-oWNED AUTOS (Ptraccldent) <br /> - , ,,--, PROPERTY OAMAGE . <br /> GARAGe: LlARIUTY ~J.i? AUTO ONL Y-EA ACCIDENT I <br /> I- ANY AUTO OTHER THAN AUTO ONL V: '" 'Imnl~IUi;) 1, <br /> f-- ! SACH ACCIDENT $ <br /> , .- . AGGREGATE . <br /> EXCESS UABILITY EACH OCGUAAI!NCE $ <br /> R - UMe~eLLA FORM AGGRE(;ATE . <br /> OTHER THAN uMBRELLA FORM $ . <br /> WORKER.S COMP~SATlON AND I STArUTORYLlMITS 'ijliiii~~'lf~,g"":nii~I':R <br /> 5MPLO\'ERS LIA.8ll.JTY ,11 .,1, I \r,,~1 I /1, <br /> EACH ACCIOENT . <br /> THe PROPRIETOR! RINCL. DISEASE-PO\.ICY LIMIT I <br /> PAATNERS/EXEcuTIVE. <br /> OF~ICE.RS ARE ""CL DISEASe-EACH EMPLOYEE $ <br /> OTHER <br />DESCRIPTION OF' OPERATlONS/LOCATlONSNEHICLES/SPEClAllTEMS <br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED-PRIMARY WORDING APPLIES PER FORM U156P-0403 <br />CERTIFICATE HOLDER CANCELLATION "10 DAYS FOR NON.PAYMENT <br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, SHQULO ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE I"HE <br />AGENTS. VOLUNTEERS AND REPRESENTATIVES EXPIM.T10N DATi THeREOF, THe ISSUING COMPANY WILL ENDEAvOFl: TO MAIL <br />20 CIVIC CENTER PlAZA ~ DAYS WRITTEN NOTICE '1"0 THE CERTIFICATE HOLDER NAMED TO tl"lE <br />SANTA ANA, CALIFORNIA 92701 LE:fT, BUT FAlL.U~1! TO MAIL SUCH NOTICE SHA1..L IMPOSE NO OBLIGATION OR <br /> LIABILITY OF ANY KIND UPON THE COM.PANY, ITS AGENTS OR REiPRESENTATIVEG. <br /> AUTHyZENTAT~ ~ <br /> l :..lX_J J A /1 .i .k <br />aWSD 2S (Oa/2000) / @ 2000 ~E SOFTWARE <br /> ..../ <br /> <br />