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Fug 04 O5 10:55a Tllagl <br />A'~ORD CERTIFICATE OF LIABILITY INSURANCE G,sT <br />paooucER THIS CERTIFICATE IS ISSUED AS A MATTER I <br />Insurance Services ONLY AND CONFERS NO RIGHTS UPON 7HE <br />Of Thousand Oaks, Inc. e~i ~aR FHrnVERAGE AFFORDED BOY THEM <br />PO Box 7329 <br />Thousand Oake CA 91359 <br />Phone:805-495-4634 Fax:805-994-0781 <br />INSURED <br />INSURERS AFFORDING COVERAGE <br />INSURERA CBIC Insurance co. <br />C le Masonry <br />4062 Morning Star Dr. <br />Huntington Beach CA 92649 <br />INSURER D'. <br />p.3 <br />DATE IMMIDDIVYVVI <br />07/29/05 <br />RMATION <br />KATE <br />END OR <br />S BELOW. <br />NAI~ <br />COVERAGES - <br />E POLICIES OF iNSVRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />SSUED OR <br />TH <br />N OF ANY CONTRACT Oft OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAV BE I <br />ANV REQUIREMENT, TERM OR CONDITIO <br />RIBED HEREIN IB SUBJECT TO uLTNE TERMS EXCLUSIONS AND CONDITIONS OF SUCH <br />MAV PERTAIN. THE INSUPANCE AFFORDED BY THE POLICIES DESC <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />I <br />LTR N D <br />BR <br />TYPE OF INSURANCE POLICY NUMBER GATE MMIDOIYY OAT£ MMIDO/YY LIMITS <br /> <br />OOO OO <br /> EACH OCCURRENCE b lO <br /> GENERAL LIABILITY <br />SCE1326 <br />02/28/05 <br />02/29/06 <br />- <br />'Tee a~en~ <br />PREMISES( <br />$ 3000_00 <br />A $ COMMERCIAL GENERAL LVIBILITY IN SOOO <br /> MED EXP (Any one perwnl S <br />_. _- _. <br /> CLAIMS MADE X^OCCUR _ <br />PERSONALBAOV INJURY~~ <br />-__.. $SOOOOOO <br />.__ __._._ - <br /> I -j ---- -"'"'- ~ _____-_. <br />GENERAL AGGREGATE S 2000000_ <br /> PRODUCTS. COMP/OP AGG 92000000 <br /> GENL AGGREGATE LIMIT APPLIES PER: <br /> PDLICY jt of LOC <br /> AUTOMOBILE LVU$ILITY ' INGLE LIMIT <br />0 ®BBIN~D S <br /> L <br />w ~- <br /> ANY AUTO <br /> AIL OWNED AVI'OS BODILY INJURY ~ <br /> (Per perwnl <br />'-- <br /> SCHEDULED AUTOS -- <br /> HIRED AUTOS BODILY IN.IVRY <br />(Pet aml0ent) $ <br /> <br />-- <br /> NON~OWNED AVT05 --" <br /> <br />i <br />- PROPERTV DAMAGE <br />(Peraw~donp S <br /> __ <br /> AUTO ONLY-EA ACCIDENT $ _ <br /> GARAGE LIABILITY <br /> <br />ANV AUTO EA ACC <br />OTHER THAN $ <br />- - -- <br /> - AUTO ONLY-. AGG $ <br /> EACH OCCVRRENCE $ <br /> EXCEB&UMBRF1lA LIABILITY <br /> ~ AGGREGATE $ -_ <br /> CLAIMS MADE <br />OCCUR - <br /> <br /> S <br />-" <br /> DEDUGJItlLE -' <br /> RETENTION $ ? ? V `' ~ _ <br />{j.~ 1 ~ F IZ=~/0 S <br /> ER <br />TORY UMRS _..-_ _ <br /> WORKERS COMPENSATION AND _ <br /> EMPLOYERB'LUIBILITV , p' E. L. EACH ACCIDENT S _- <br />ANY PftOPR1ETORNARTNERlE%ECUTNE <br /> <br />OF~ICER/MEMBER EXCLUDED? <br />' <br />~~ <br />~._ - ~ I I <br />~'=>- <br />-- <br />E.L. DISEASE-EA EMPLOYE <br />E $ <br />----- <br />~ <br />' _ <br />i <br />~ t( ~I' <br />=~L(" S <br />Il yes tlewrlba antler le <br />L.e l .- E.L 019EA$E-POLICY OMIT <br />SPECIAL PROVISIONS below <br />"T <br />- - <br /> OTHER •,'nl1;t~ ~,: ,: <br />j?II <br />v I A <br />CRIPTION OF OPERATIONS / LOCATION9l VEHICLES I EXCLUBION8 ADDED BV ENDORSEMENT I SPECIAL PROVISIONS <br />DES <br />The City of Santa Ana, its officers, agents and employees are named <br />additional insured. 10 day notice of cancellation may apply for non--payment <br />of premium. <br />S.~rr~N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXRRATION <br />GATE THEREOF, THE ISSUING INSURER WILL BNBiAVBR-lID MAIL 3O DAYS WRITTEN <br />NOTICE TO THE C[RTIFICATE HOLDER NAMED TO THE LEFT, 801'MRCDRETO~O'BB-BYAIL <br />The Depot at Santa Ana <br />1000 E Santa Ana Blvd 8108 <br />Ssnta Ana CA 92701 <br />!20011881 <br />