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<br />I Ai;pRJ)N CERTIFICATE OF LIABILITY INSURANCE OP ID 1~ DATE (MM/DDIYYYY) <br /> URBAN-1 05/05/04 <br /> '..RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> ISU Ins Srv - Fullerton Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 1150 E Orangethorpe Ave,#101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Placentia CA 92870 <br /> Phone: 714-577-5800 Fax:714-577-5888 INSURERS AFFORDING COVERAGE NAIC# <br />!¡r¡SURED ---. A - ~OO3 -õl..DS INSURER A: Western Heritage Insurance <br /> INSURER B: <br /> Urban Graffiti Enterprise INSURER C. <br /> Juan Reinoso <br /> P. O. Box 2383 f/ ;, lJ¡J;;J. INSURER D <br /> Covina CA 91722 <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TFRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE IN' JRANCE 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 />A <br /> <br />TYPE OF INSURANCE <br />GENERAL LIABILITY <br />X ~~MERCIAL GENERAL LIABILITY <br />I~ CLAIMS MADE ~ OCCUR <br />~l Owner / Con t:~~~t--"- <br /> <br /> <br />~'L AGGREGATE LIMIT APPLIES PER <br />PRO- <br />JECT <br /> <br />POLICY NUMBER <br /> <br /> <br />LIMITS <br /> <br />LTR NSR <br /> <br />~----- <br /> <br />$ 1000000 <br />$ 50000 <br />$ 1000 <br />$ 1000000 <br />~--- <br />$2000000 <br />$ 2000000 <br /> <br />EACH OCCURRENCE <br /> <br />SCP0504460 <br /> <br />02/18/04 <br /> <br />02/18/05 <br /> <br />PREMISES (Ea occurence) <br />MED EXP (Anyone person) <br />PERSONAL & ADV INJL'RY <br /> <br /> <br />GENERAL AGGREGATE <br />PRODUCTS - COMP/OP AGG <br /> <br />LOC <br /> <br />SCHEDULED AUTOS <br />HIRED AUTOS <br /> <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />BODILY INJURY $ <br />(Per person) <br />BODILY INJURY $ <br />(Per accident) <br />-~ <br />PROPERTY DAMAGE $ <br />(Per accident) <br /> <br />ANY AUTO <br />ALL OWNED AUTOS <br /> <br />NON-OWNED AUTOS <br /> <br />GARAGE Ll/IILlTY <br />ANY AUTO <br /> <br />OTHER THAN <br />AUTO ONLY: <br /> <br />AUTO ONLY - EA ACCIDENT $ <br />EA ACC $ <br /> <br />-- <br /> <br />EXCESS/UMBRELLA LIABILITY <br />OCCUR D CLAIMS MADE <br /> <br />EACH OCCURRENCE <br />AGGREGATE <br /> <br />AGG $ <br />$ <br />$ <br />$ <br /> <br />DEDUCTIBLE <br />RETENTION <br /> <br />$ <br /> <br /> <br />$ <br />$ <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFiCER/MEMBER EXCI.UDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br /> <br />~. <br /> <br />$ <br />E.L. DISEASE - EA EMPLOYEE $ <br /> <br />~- <br /> <br />----'--. <br /> <br />E.L. DISEASE - POLICY LIMIT $ <br /> <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />The certificate holder is named as additonal insured with regards to general <br />liabiliy for work performed by insured per the attached blanket endorsement <br />CG 2033. Re~)ve Graffiti.* 10 days notice of cancellation for non <br />payment of premium. <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />SANTAA2 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL I!IJII J IR 1'0 MAIL * 3 0 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,IMH r UL fl 81a n.c.;S!I'" LI. <br /> <br />City of Santa Ana <br />Public Works <br />Projects Mgr <br />220 So Daisy <br />Santa Ana CA 92703 <br /> <br />IMPQOill1 !BLlaA..TIG'~""",",U'L'II.......... ~ITI ~'\II"u"UrJW <br /> <br />J-1JR~8i ITS A8EIJlJ8 ôn. <br /> <br />TTL" T "'fl"rs. <br />AUTHORIZED REPRESENT A TI"'--, <br />.-.-.,._>._~. <br />David Hood / <br /> <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br />¡YLo/ <br />