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<br />Sep 06 05 02:2lp
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<br />Public Works
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<br />Yard
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<br />714-647-3342
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<br />p.2
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<br />JAN 31 2005 2:13PM
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<br />HP LASERJET 3200
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<br />p. I
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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE I ""no (fttoIIOOm'YY)
<br />l'M. i OCT l8 Ool
<br />PRODUCER lHIS CERllFlCA'T5 18 ISSUED AS A MA.TTER OP WORMATION
<br />,.t '_INSURANCe BROKERS, INC. OM.. r AH[) CONfeRS NO RttJIfTS UPON THE cER.TFICATE
<br />, ,.. weST GRANT LINE RD. -.oLDER. Tlfll CERnFlCAT~ ~ W\T a.Unlf\ e'll'TS'un t\8
<br />lllACY CA 96'71 ..'';:. r... ;;;;"-;;;'ioi;'Mf' '"
<br />~~cv U,"" 0015034 ' INSURERS AFFORDING COVERAGE NAIC .
<br />~"A Sl:omDAl~ INSURANCE COMPANY
<br />INSUReD ,-' --,~
<br />CONSOLIDATED DATA CONTROLS IINSURER B ,~"~
<br />1590 S. ANAHEIM BLVD.. SlJITE D -~---
<br />ANA~E1M CA mo5 INSURER C ------ --- -, -
<br /> ~.:SURER 0: ,-
<br /> INSURER E
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<br />COVERAGES
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<br />POliCIES. A'GOIUiCl\TE UMfTS SHOWN MAY H!WE BEEN REDUceD 1:~' ?;.;-.
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<br />TYPI!.ClPJI.I6UMNCl:!
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<br />POL""'\' NUMlJR
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<br /> - ~;':=AALUA9IU1Y ClS10l4l186 OCUIl4 I ocno. I EACH OCCuR~C1: --I' 1,OOlJ,,000
<br />AI ^, co~GE~AALLNIl.IT ClI\MAI3 TO IlEJIITflO . 1DO.COO
<br />13? ~..~~ OCOUR ~.""",..- ..-
<br /> , j M1!D. EXP (Al1t one periM) . 5,000
<br /> I PiORSONAL LAt:N IHJilRY . 1,000,000
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<br /> i i (;;ENERAl ACGREGATE . 2,000,000
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<br />'~~~~T~n::1 f'ROOUCT&-GOMPIOP AGIG. . 1,OOO!GGO
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<br /> t HIR€O AUTOI ! i RQblLvINJUR.Y
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<br /> i- PftOPER'T'Y DltMGE .
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<br />i GAAAGE UAIIlJT'1 1 i ! ~~Y-EAACC~ENT ,
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<br />=l ANY AUTO j OTI'rf'RTHo'IN I^AC.<-&--__
<br /> , l AUTO ONLY .~ ,
<br /> E'Mens I UlltBRaL. LlAIILJTY I f.'.CHOCCU~ .
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<br /> _,] OCCUR D ClAIMS !MOE ~REGATf .
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<br /> -==] DEDUCTIBlE I - __1'-- ~,--
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<br /> RETENTION :s: ,
<br />WOI*EJt$ t::QM~11ONNID , WCITATlJ-, l__l~._
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<br />A1il'lFtllCflI.TCI~lICUft\lli I E,t,. EACfI ACCDENT t
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<br />II'IiCML PIlO'lIIlOMI !,elgw E.L DlSEASE-POLM;Y 1I1111T f
<br />. rOll"tER' i
<br />DeSCRIPTION 01' OPERATIO/oISIlOCATlONSNEHIClESIEXCl.USlONS ADDeD SY eNDOIlSEM~TI SPECIAl PROVISIOIolS
<br />"'CITY OF SANTA ANA, ITS OFFICERS, EIII'LDYEeS, AGENTS AND VOLUNTEERS ARE SllOWN AS ADDITIONAL INSURED.llur ONLY WlT11
<br />RI!SPECT TO Tl4E aENeRAL LIABILITY ARISING OUT OF THe O~TIONS PERFORMEO BY"f'toff NAMED INSURED .AODmONAL
<br />ENDORS~IIIENT TO BE ISSUED BY CARRIER'ID DAY NOMAY, all DAYS AlL OTt1ER8
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<br />C F
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<br />NTV '=* ~NTA ANA
<br />,. CeNTER PlAZA
<br />SANTA ANA CA 12101
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<br />C CEt.LATION
<br />6HOUlg fIW( OF THE ABOVE 0E8CRf1EO POlJCE8 liE C~llEf) BE;-, -,,-
<br />EXPiRATIQN OATE THEREOF, TrlE mU1N[I, COIrlf'ANV WIll Ml\JL 30 ~YS \Wlri~
<br />fIIOTICI:' TO THe CEFllFlCATE HOLDm NAM!Co TO 1I-lt ltFT
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<br />Alloftl/<ln:
<br />ACORD 25 (20011Oi)
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<br />Certifiea tI 17&97
<br />Laura Stitt Sheedy
<br />Assistant City Attorney
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