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<br />AroRQ. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
<br />04/13/2004
<br />PRODUCER (310)309 2268 FAX (310)309-2568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Sander A. Kessler & Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />2850 Ocean Park Boulevard, Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Santa Monica, CA 90405
<br />ATTN; SHEILA GREEN INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Western All ied Corporat10n INSURER A Travelers Indemnity Co. Of IL
<br />12046 E. Florence Ave. INSURER B Great American Insurance Co.
<br />Santa Fe Springs, CA 90670 INSURER C
<br /> INSURER 0
<br /> INSURER E
<br />
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />INSR DO'
<br />
<br />p~H.~~ EFFECTIVE POLICY EXPIRATION
<br />11/01/2003 11/01/2004
<br />
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />
<br />TYPE OF INSURANCE POLICY NUMBER
<br />GENERAL LIABILITY Vl EJ-CO-2394A386 TIL-03
<br />X COMMERCIAL GENERAL LIABILITY
<br />~ ~ CLAIMS MADE [!] OCCUR
<br />
<br />MED EXP (Anyone person)
<br />PERSONAL & ADV INJURY
<br />GENERAL AGGREGATE
<br />
<br />A
<br />
<br />X
<br />
<br />A
<br />
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />I POLICY m j~g n LOC
<br />~TOMOBILELlABILlTY Vl ]-CAP-2394A398-TIl-03
<br />X ANY AUTO
<br />-
<br />-
<br />X SCHEDULED AUTOS
<br />X HIRED AUTOS
<br />X NON-OWNED AUTOS
<br />cc;.
<br />
<br />PRODUCTS - COMPIOP AGG $
<br />
<br />11/01/2003
<br />
<br />11/01/2004
<br />
<br />COMBINED SINGLE LIMIT
<br />(Eaaccident)
<br />
<br />ALL OWNED AUTOS
<br />
<br />BODILY INJURY
<br />(Per person)
<br />
<br />~()odo 1/3
<br />-(I-:
<br />
<br />BODILY INJURY
<br />(Peraccidenl)
<br />
<br />PROPERTY DAMAGE
<br />(Peraccidenl)
<br />
<br />~~GE LIABILITY
<br />I ANY AUTO
<br />
<br />AUTO ONLY - EA ACCIDENT $
<br />EA ACC $
<br />AGG $
<br />,
<br />,
<br />,
<br />,
<br />,
<br />
<br />OTHER THAN
<br />AUTO ONLY
<br />
<br />B
<br />
<br />~~SSlUMBRELLA LIABILITY
<br />~ OCCUR D CLAIMS MADE
<br />
<br />TSU2533433 11/01/2003
<br />
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />
<br />11/01/2004
<br />
<br />t DEDUCTIBLE
<br />I RETENTION
<br />
<br />,
<br />
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />A ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />II yes, describe under
<br />SPECIAL PROVISIONS below
<br />OTHER
<br />
<br />VTRJ-UB-2394A374-03 11/01/2003
<br />
<br />x wc STATU-
<br />
<br />11/01/2004
<br />
<br />E.L. EACH ACCIDENT $
<br />EL DISEASE - EA EMPLOYE $
<br />EL DISEASE - POLICY LIMIT $
<br />
<br />LIMITS
<br />,
<br />,
<br />,
<br />,
<br />,
<br />
<br />10J.';'-
<br />
<br />1,000,000
<br />300 , ooe
<br />5,OOe
<br />1,000,00C
<br />2,000,00e
<br />2,000,000
<br />
<br />,
<br />
<br />1,000,000
<br />
<br />,
<br />
<br />,
<br />
<br />,
<br />
<br />5,000,000
<br />5,000,000
<br />
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />
<br />...Dl'SCRIPTION pF OPERATION:; I LOCATIONS VEHICLES I EXÇLUSIONS ADDED BY SNDORSEMENT I SPEiCIAL PROVISIONS
<br />~E: SerV1Ce - ThlS insurance applles separately to each lnsured against whom claim is made or suit is
<br />
<br />,rought except with respect to the company's limits of liability. The inclusion of any person or
<br />
<br />>rganization as an Insured shall not affect any right which such person or organization would have as a
<br />
<br />:laimant if not included. Additional Insured endorsement attached.
<br />
<br />Except 10 Days Notice of Cancellation for Non-Payment of Premium.
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL~){ MAIL
<br />*30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />-JW(XiOOII6JOO(-J6JOO¡¡ fI61lJ6 (XiJOOI (XX
<br />-)iJIi1i_JIII~-_XXXXXXXXX
<br />
<br />~
<br />
<br />City of Santa Ana
<br />Building Maintenance Superintendent
<br />20 Civic Center Plaza, M-11
<br />Santa Ana, CA 92702
<br />
<br />AUTHORIZED REPRESENTATIVE
<br />Sheila Green SHEILA
<br />
<br />@ACORDCORPORATION 1988
<br />
<br />ACORD 25 (2001/08) FAX;
<br />
<br />(714)647-5421
<br />
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