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<br />~¡¥Un;.,,;.pality <br /> <br />.,' - <br /> <br />:tnt ~-:!"l} 64.7r;11 at 4/21/2004 <br />ertìjlCUle OJ ..nsurance <br /> <br />SJHII1ø Program <br /> <br />3:41 PM <br /> <br />tiame IDsured: <br />.eroy Vasquez Construction <br />;222 Concha Drive <br />.1ira Lorna, CA 91752 <br /> <br />Named AddIUoaallnsand: <br />SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Senta Ana CA 92701 <br /> <br />:ertificate # <br /> <br />~overage <br /> <br />~imits <br /> <br />}edudihles <br /> <br />['erms & <br />~oDditioDS <br /> <br />~u:lusiODS <br /> <br />SSAOJ-0011 <br /> <br />SPARTA JNSURANCE PROGRAM: Conunercial o.neml Liebility - Hazard 2 <br />Contract Value: 59,800.00 <br />Coverage Period: 4/21/2004 to 4/21/2005 <br />Insurance Camer: Essex Insurance Company <br />Master Policy: 3CM4080 <br />Master Policy Efl'ective Date: 11/15/2003 to expiration <br /> <br />52.000,000 General Asgrepte / 51,000,000 Each occurrence / 51,000,000 ProductsICompleted opeœtiow / <br />51,000,000 Personal & Adveru.mglnjwy / 550,000 Fire Damage/Medical Payment> Excluded <br /> <br />5500 BI & PD Per Claimant Includin¡ Looa Adjustment Expense <br /> <br />5950.00 Premium (Fully Earned) <br />529.69 Taxes (Fully Earned) <br />550.00 Certificate Fee (Fully Earned) <br /> <br />TRIA <br /> <br />51,029.69 Total AmOlmt <br /> <br />I. No Cancellations Allowed. PrenUum, taxes and fee. are fully earned at inceptioo. <br />2. Opeœtíons and Iùding Based: CoolIactor - Will be sandblasting and scalmg brick building for The City of Senta <br />Ana. <br />3. Department Comnumity Development Agency <br />4. Additional Insured(.): Not Applicable <br />5. NO PROFESSIONAL LlABIIlTY COVERAGE PROVIDED. <br /> <br />Asbestos, Assault & Battery. Employer Related Practice" Subsidence, Independent Con_tors. Pollution, 00.. Suit, <br />Lead or Silica Dual:. Mold or Bio-organic Growth or Mildew, Ptmitive Damages, Animal, Breach of Conlnct, Y2K <br />Electronic Dats, Medical Payments, War or Terrorism. <br />The insurance provided under tills policy is limited to your worl< perfurmed on behalf of the entity named .. <br />. Additional Named Insured" above and doe.n't extend itself to any other worl< performed by you or your organjzation. <br />Coveœge is limited to the description of operations and rating bas"listed in "Tenns & Conditions" item 2. <br /> <br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, Inc. 1920 East 17th <br />St Suite 136, Santa Ana, CA 92705 <br /> <br />i' ~ '< <br /> <br />:' ; ii. (\,r <br /> <br />~~ <br />~.I' <br /> <br />Carol Frost I President <br />Municipality Insurance Services. Inc. <br /> <br />rd'J '1< (¡\ !c'" <br /> <br />r/~. <br /> <br />L~ ' ..-.." ,,-. ¡ \ ~ ,_.~ i \". !...; ~ <br /> <br />1920 East 17th St Suite 136 SaotaAna, CA 92705 (800) 420-0555 (714) 550-5040 fax (714) 550-5044 License# QC04849 <br /> <br />001/001 <br /> <br />~ <br />