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<br />.te: 911/2005
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<br />Time: 9:21 AM To: City of Santa Ana @ 9,1-714-647-6930
<br />page-,-~~____
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<br />i ACORQ,
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<br />I 'oeDUCER (916)443-0200 ~AX (916)443-0251
<br />I' Owen Dunn Insu~ance Services
<br />License Number: 0670167
<br />! 2831 G Street Suite 200
<br />I Sacramento, CA 95&16-3721
<br />
<br />I""uo., ~~~e~~i~~m:~r~~::~~c;e~~~~~~e:-- n __n_
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<br />I 241 lathrop Way . .
<br />I Sacramento, CA 95815 N_;?,oo'l-I<JS .
<br />. N. iNJ01-fJ-.Y-OI
<br />
<br />----~ATE(*Ci:;~)-i
<br />
<br />09(01(2005
<br />
<br />THIS CERTI~ICATE IS ISSUEDASA MATTER OF JN~ORMATION I
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />'L HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BelOW. ~
<br />
<br />, INSURERS A~FORDING COVERAGE ! NAIC N I
<br />
<br />-~;~~:~r~.:7::=!!,~ve fers Ind~.!x~Co~any ---+---=_~~=-~~~=-~i
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<br />':Sl;~:::"l; Travelers Propel"'ty & Casualty--rnfCol
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<br />Ir~CiU<;-~~. Travelers Indemnity Co of IL: .~
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<br />CERTIFICATE OF LIABILITY INSURANCE
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<br />! AU1'OMOSllE LIABILITY
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<br />Exn04A197' 07/01(2005 , 07(01/2006
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<br />I WORKERS COMF'ENSATION AND
<br />: EMPLOYERS' llABIlIT{
<br />I C 'I' .:.,1"1 ~OF'O::;IET(;Rfi='ll,R"'-I~ERIE~ECP' <'10
<br />C:F=IC:::;;>I;~Ei~3c;< f)<CL;_'[:E~'"
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<br />tII;~CII:IP1ION OF' OPE'UllON$ I LOC~nONS I VEHICLES I EXCLl,;SONS ADD~ ev EN;'O I, ~rMiI~~s
<br />e. Test ~en~a~ Servlces .. A" ISUiiH.~ity Atl()l':l(~\
<br />eneral Llablllty Blanket Add,tlonal Insured en~orsement per attached
<br />
<br />UB1176AOiOiOl 07/01(2005 ' 07(01/2006
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<br />ABlHW-M#l,> ~" 'iW' ~('rltW
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<br />CG0246 1002
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<br />----1
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<br />upon nonpayment of pnemium, 10 days notice of cancellation will be given.
<br />
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<br />C!;RTIFlCATI; 1-401 n~R
<br />.
<br />
<br />City of Santa Ana
<br />Pe~sonnel Se~vices, M-24
<br />Attn: Waldo Barela
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />
<br />l1CE" ATION
<br />SI-lOULD ANY ,:iF THE ABOVE' :JESCRI8ED POLICiES BE CANCELLED BEFORE THE
<br />e~p:FlAT'ON DATE THEREOF, T"lE ISSClING INSURER WLl ~~ M,lOIL
<br />30"~ DAYS "':R;TTEN NO"lce TO THE: ceR"nFICATE I-lQt.OIiR Nl>,MiD TO Tf1E L;,-n
<br />KOOlllI~_JIIOOII(~JllIO:llll~I0;~XXX
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<br />AUTHORI2EO REP~ESENTA-IVE ','i~",,~~...,..._ C /Zr-'I>"~__
<br />~an:!I!~_~o~ak/LLR :j
<br />,l)ACORD CORPORATION 1';88
<br />
<br />i
<br />ACORD 25 (2001f08) FAX:
<br />
<br />(714)647-6930
<br />
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