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<br />JAN 31 2005 2:13PM
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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE , DATE IMMlDOfYYYY)
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<br />'M , OCT1a D4
<br />PRODUCEFl: THIS CER11F1CATE 1$ lISUEO AS ... MATTEA OF INFORMATION
<br />. 'L ToIMONT INSURANCE BROKERS, INC. ONLY AND CONFI!RS NO R1Gf1TS UPON THE CERTIFICATE
<br />,",. WEST GRANT LINE RD. ftOLDER. THIS CERTIFICATE !Inll:Q IdnT ...II-=ldn CYTEIt,.l" na
<br />TRACY CA 95376 ALTER THE COVERAGE AF;::'--
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<br />Aaencv L1cl1: OC15034 i INSURERS AFFORDING COVERAGE NAICf
<br />INSURED y/- '-f INSURER A: SCOTTSDALE INSURANCE COMPANY
<br />CONSOLIDATED DATA CONTROLS N.-;}.o~ - II !INSURER B:
<br />1590 S. ANAHEIM BLVD.. SUITE 0 1--------- ,.. --
<br />ANAHEIM CA t2805 INSURERC . -- ~_.- i
<br /> INSURER D; i
<br /> ~--_.- -'---- ut
<br /> INSURER E
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<br />COVERAGES
<br />1,10110 I>n,w,,,~,,~ ,~":,'o,,.......,. "~ 1:11:1 ""'\AI ....."': ....:I:OJ ,,,,..,,"'''' T^"f"UC 1!J"'ID~n ..A...." ___,._.
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<br />.~_.!t~!E_~! .!O-"'~_~~_T~~ CERTIFICATE MAV BE ISSUED OR
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<br /> AlITOOM...,(.E,,-~g\.II_ .
<br /> -oT~ER T-i,l,N ~~<;:C .
<br /> AUTO ON!.. '( .= .
<br /> I EACH OCCURRENCE it
<br /> I AGGREGATE ,
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<br />[ H. e-ACI1 ACCIDENT ,
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<br /> E.L DISEASE..u. EMPLOVEE ,
<br /> E.L. OtSEASE-POLlCY_IWT "
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<br />POliCIES. AGOFUOCATE LIMITS SHOYtfN W\Y HAVE llEEN- REDU:ED =r:' =':'~-,
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<br />Nil{"'OO\.i
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<br />TYPE OF IN-8tJRANCe
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<br />POllCYNUMBER
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<br />~CIl.IC't.~-
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<br />OCT 3 04
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<br />OCT 3 QS
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<br />tACH OCCURRENCE
<br />J"""'Gti:TQ~lIlTEO
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<br />A
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<br />-~..~_4.L UABlUTY
<br />^ _ \;uriWii:.Rcw. GENERAL !..lABILlT
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<br />:+e~IMS~W oceu.,
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<br />: GEN'L AGGRE~ LWIT APPllFS PERi
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<br />MED. ex'p (AAy 0'" perlO'"
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<br />PERSCNA!.. &. AOV INJURV
<br />I GENERAL AGGREGATE
<br />PROOUCTS-COMP/OP AGG.
<br />____mm 'm
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<br />CLS1044866
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<br />AUTOIIOBlLE llASlllTY
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<br />CONBrNEO SINGLE. L-fMIT
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<br />. 80DlL Y NJURY
<br />(PerplJfSOf\l
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<br />; I ANY AUTO
<br />1.---1 ALLOWHEOAU~08
<br />1--1
<br />,_-' i SCHEOl.;LE~""UT08
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<br />~ ::~='AVTO$
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<br />BODIlY INJURY
<br />'(PetlltclGenl)
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<br />
<br />~, GARAG! UA!lILITY
<br />!~ ANY AUTO
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<br />1 eXCESSJUIlBRalAllAIItJTt
<br />i~ OCCUR 0' CtAtMS MADE
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<br />1--1 OfotJCTIBlE
<br />i RETENTIONS:
<br />WORkERS COUPENSAnoN"ANO
<br />I !IIPLOYl':RS' lIABilITY
<br />A1fY ~llCl'ItIlTOllP.lJt1NIAllueU1Ml
<br />OFFICEItIfIIEMl.EREXCLUDEO?
<br />.V-..dtnltllllundD!
<br />al'EC1AL MOVIaIONllllelow
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<br />OTHER.:
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<br />. 1.QQO.QIIO
<br />. 100,QOO
<br />, 5,000
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<br />-'-__ 1,1100,001)
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<br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCWSIOItS ADDED BY ENDORSeMENTI SPECIAL PROVISIONS
<br />"CITY OF SANTA ANA, ITS OFFICERS. EMPLOYEES, AGENTS AND VOLUNTEERS AR! SHOWN AS ADDITIONAL INSURED, BUT ONLY WlTH
<br />RESPECT TO THE GENERAL LIABILITY ARISING OUT OF THE OPERATIONS PERFORMED BY THE NAMED INSURED 'ADDmONAL
<br />ENDORSEMENT TO BE ISSUED BY CARRIER '10 DAY NOII.pAY, 30 DAYS All OTHERS
<br />
<br />FI T
<br />r.ITV ~ 54.NTA ANA
<br />C"ENTER PLAZA
<br />SANTA ANA CA 92701
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<br />
<br />CANCELLATION
<br />SHOUlO ANY OF THE ABOVE DfBCRIBfO POlICIES BE CANCELLED e~.'"'-:'
<br />EXPIRATION DATE THEREOf, THE ISSUING COMPANY WIll MAIl. 30 DAYS WNtnEN
<br />,"'OTtCE TO THE CERTlFICAiE HOLDER NAMED TO THE LEer.
<br />
<br />AIItnllon:
<br />ACORD :Ii (ZClO1lOa,
<br />
<br />
<br />0&44907 @ACORD CORPORATION 1998
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