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<br />o( <br />. <br /> <br />: <br /> <br />Association of California Water Agencies I Joint Powers Insurance Authority <br />5620 Birdcage Street, Suite 200, Citrus Heights, CA 95610 <br /> <br />CERTIFICATE OF COVERAGE <br /> <br />THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN <br />THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />COVERAGE DOCUMENTS LISTED HEREIN, <br /> <br />MEMBER <br />Orange County Water District <br />P,O. Box 8300 <br />Fountain Valley, CA 92728-8300 <br /> <br />COVERAGE INFORMATION <br />This is to certify that coverage documents listed herein have been issued to the Member Agency herein for the Coverage period indicated. Not withstanding any <br />requirement. term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the <br />coverage documents listed herein is sUbjE!ct to all the terms, conditiçms and exclusions of such coverage documents. <br /> <br />T e of Covera e Certificate # Effective Date Ex ¡ration Date <br /> <br />General liability <br /> <br />Commercial General liability <br /> <br />Contractual Liability <br /> <br />Products/Completed Operations <br /> <br />Occurrence <br /> <br />Limits <br /> <br />Auto Liability <br />Owned Autos <br />Hired Autos <br />Non-Owned Autos <br /> <br />Auto Physical Damage <br />Scheduled Autos <br />Hired Autos <br /> <br />Property <br />Special Form <br />Mobile Equipment <br />Boiler and Machinery <br />Crime <br /> <br /> <br />Workers' Compensation <br /> <br />MOWC&EL-070103 <br /> <br />7/112003 <br /> <br />7/1/2004 <br /> <br />ø Coverage A - Workers' Compo Per Accident Statutory limit <br />ø Coverage B - Employer's liability Per Accident $2.000,000 <br />CERTIFICATE HOLDER DESCRIPTION <br />The City of Santa Ana MWD Long-Term Groundwater Storage Program <br />Attn: City Manager <br />P,O. Box 198B <br />Santa Ana, CA 92702 <br />CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date thereof, ACWAJJPIA will BAdBa"ar ta provide 30 days written <br />notice to the certificate holder named herein. <br /> /: /1.1 (j.GJ,~~~ <br />Signed by: \;W ."A. Date: March 30. 2004 <br /> (Authþrized Represé';¡.@.ve) <br /> '/ <br /> V <br />