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<br /> QN~' ANU L;UN~"""'.v ""'",~ u~v.. '"~ "'~~"nv^'~
<br />W.",ds , Grooma, Inc:. HOLDER. THIS CERTIRCATE DOES NOT AMEND, EXTEND DR
<br />529 Wash¡nqton street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Columbus IN 47201
<br />Phone: 812-3'13-4435 Fax: 812-J7 3-4445 INSURERS AFFORDING COVERAGE NAJCII
<br />IN"""ED .' 1../-.'),('c1 ~ [eif INSU.E.., C"..nni., 'n.~<o ""-' 19909
<br /> INOUREO Bo ." """b. ...""', ,,-_.. 19895
<br /> cmins Cal Pacific LLC INSU""O c,
<br /> î~£n~QQcr'9~~~u" INS_. D'
<br /> INSU"""_;
<br />
<br />COVERAGES
<br />T>lo POLlCIôS OF INSURANCE LlSToD saOWHAvE Be.. ISSUEDTO_I",U.'" -ED ASO\'E FORntE POLICY pE.'o<> ,,",!CATED. NOTWITHSTANDING
<br />""""OU'RE"""-, Tem! DR CONDITION OF ANY COHTRACT OROTHER DOCU~"TWIT>l RESl>EI:TTO ""'CH nosCER1'IFIC>\TE MAYBE ',,""!PeR
<br />MAY PEOrAlN. T>lE INSlmNCE AFFORom B' THE POLICIES DESCRIBED H,,"EIN IS ",,""Ecr TO Ace THE 'ERM.. EXCLUOIDNS AND COHMID"," OF sue"
<br />POLICES. ADGR5GATE L""ITS SHOWN NAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />LTR !II TYPE OF INSU",,"CE POLlC'tNUMBER
<br />GEN!RALUA.IIJTY
<br />A X X COMMERCIALGENERALLlA81l1TY 743008128
<br />CWMSMADE ŒJ OCCUR
<br />A X Sroad Form LiaJ:>
<br />A X Cont:ractua~ Liab
<br />
<br />DATE ."'D
<br />
<br />ATE MMIO
<br />
<br />08/01/0J
<br />
<br />08/01/04
<br />
<br />",CHOC<:URRENCE
<br />FRËMISES eo """""".
<br />MED EXP I.W one""",,}
<br />PERSONAl,' N:N INJURY
<br />GoNERALAGGREGAre
<br />PRODUCTS-COMFIOP AGO
<br />
<br />LIMITS
<br />~1 000,000
<br />S Included
<br />$5,000
<br />n 000 000
<br />51,000 000
<br />S 1,000 000
<br />
<br />
<br />
<br />~
<br />
<br />CO~",NED61""L. LIMIT
<br />(Ea oca"nt¡
<br />
<br />il,OOO,OOO
<br />
<br />A
<br />A
<br />A
<br />
<br />AUTOIolORiLE LIAIIIUTY
<br />A X X -,uro
<br />ALL OWIED AUTOS
<br />SCHEOOLEO ","os
<br />X HO\EDAUTOS
<br />X NON-OWNEDAOTOS
<br />X Auto Phy.. D_qe
<br />
<br />.OOUINJURY
<br />IP"....",,¡
<br />
<br />743008128
<br />
<br />08/01/0J
<br />
<br />08/01/04 BODILYINJU""
<br />IPer""',onl)
<br />
<br />EXOUSlU~. RILLA UA BlUTY
<br />()ÇCUR 0 OLAIMS_E 743008129
<br />
<br />08/01/03
<br />
<br />P~I'YD.<MAGE
<br />Iper_nl)
<br />
<br />AUTOONcY.EAi\CCIDENT ,1 000 000
<br />08/01/04 OTHER THAN EAAce,
<br />'UTa ONLY' AGG ~
<br />"""" acOU"""""" . 5 OOC 000
<br />08/01/04 AGDRB3A'" .5 000 000
<br />.
<br />5
<br />5
<br />
<br />
<br />74JO08128
<br />
<br />08/01/03
<br />
<br />DEDUCTIBLE
<br />X RETENTION 510 000
<br />WORk'" COMPENSATlDII AND
<br />B :;;:'~:"':',,'::TNERJE)CJ¡CUn""
<br />.-.. O""œR<M.~"."'""U""c-r
<br />g~~!lt.~V~NS b-
<br />DTIIER
<br />A Property Insurance
<br />
<br />400532114
<br />
<br />08/0J'/03
<br />
<br />x TORY LIMIT'
<br />08/01/04 E.L.;ACHACCIOEN'I' 5500 000
<br />E.LDISEASE.EAEMP'O""E $"SÓO OÓO
<br />E.L.DISEASe.l'DllCYllUIT '500 000
<br />
<br />743008129
<br />
<br />Da/Ol/OJ
<br />
<br />08/01/04
<br />
<br />Spec Fol:1D
<br />RC
<br />
<br />A
<br />
<br />DESeRIPTIOII OF DPI1IA1'ION&/lOCAnoNSlvEHCLU /IXC"""'_"D",," END"""""ENT'...OIAl"RO\I1SION&
<br />Diesel engine sales and serv1oe. The City of Santa. Ana. , its offiosrs,
<br />OIMIploy......, &.gents, volunteers, and repre.entative. are added a. additional
<br />insured. for work p,u:formed, but only as respecta tc> Cwmnin. Cal Pacific,
<br />LLC's sole negliqance. f..x323-869-7499 Susan Morales
<br />
<br />lI:tPO'rSA
<br />
<br />CANCELLATION
<br />..aULD ANY OF THE ABOVE OEOCR'.'. POLICIE' BE CANOELLED ",oRE T>lE nPlRAT1ON
<br />.ATE THEREOP, "'" ",UING ","URER WII.~ MAIL ~ DAYS womac
<br />NDT\œTOT>lEOER11F1CA", ""lDEI<_DTbTl,. L<FT. -,~ .on n.'~ "n'~ "-L
<br />_........,. "."OAw' 0'01" OF . """'0' "15""'"' 11.'.0_."
<br />
<br />CE!l.T1F1CJ\Æ HOLDER
<br />
<br />The Depot "s Santa Ana
<br />C.~o1yn ru11e:ton
<br />100a ma.t Santa Ana Blvd. *108
<br />Santa. Ana CJI. 92701
<br />
<br />
<br />?U~
<br />
<br />ACORD 25(2001108)
<br />
<br />~ ACORD CORPORATION 198E
<br />
<br />(!Od
<br />
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