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. I ACOR~M CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYI 811 3/04 PRODUCER 206-701-5000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Acordia ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA License # 0531007 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 91143 Seattle, WA 98111-9774 INSURERS AFFORDING COVERAGE INSURED INSURER A: First National Ins. Co. , AIDS Housing of Washington General Ins. Co. of America 2014 East Madison St, Ste 200 INSURER B: Seattle WA 98122 INSURER C: Alaska National Insurance Co A - OW'-\ - o~(o INSURER D: I INSURER E: t~l.il" COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER ~<i~~v,,~!!'~%~~~ Pgk!fEY,~J:~;':~~ LIMITS LTR A GENERAL LIABILITY 25CC04149010 1/02/04 1/02/05 EACH OCCURRENCE $ 1000000 r-- X COMMERC!AL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 200000 ~ CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 10000 f--- ~ STOP GAP $1M/$1M/$1M PERSONAL & ADV INJURY $ 1000000 ~ EMPL Y BEN EMPLOYEE BENEFITS GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: LIABILITY LIMIT: PRODUCTS - COMP/OP AGG $ 1000000 ~ 'hPRO. h 3000,000 AGG. POLICY JECT LOC A AUTOMOBILE LIABILITY 25CC04149010 1/02/04 1/02/05 COMBINED SINGLE LIMIT - $ 1000000 ANY AUTO lEa accident) - ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS (Per person) - - HIRED AUTOS BODILY INJURY $ L NON-OWNED AUTOS (Per accident) L BUSINESS A I 1,< PROPERTY DAMAGE $ AUTO " I (Per accident) GARAGE LIABILITY fa J :v7Ir~ AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO EA ACC $ 'vv . OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY V V- EACH OCCURRENCE $ ~ OCCUR D CLAIMS MADE AGGREGATE $ $ ~ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 481658 7/01/04 7/01/05 I WC STATU'} IOTH- X TORY LIMITS ER i EMPLOYERS' I.!ABIIITY E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE $ 1000000 E.L. DISEASE - POLICY LIMIT $ 1000000 B OTHER LP7744238 1/02/04 1/02/05 PROFFESIONAL L1AB $1.000,000 PER OCCURRENCE $3000000 POLICY AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS SEE ATTACHED FOR SPECIFIC WORDING REGARDING ADDITIONAL INSURED INTEREST. JHWL CERTIFICA TE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLA TlON City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil ~ DAYS WRITTEN Attn: Clerk of City Council NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL PO Box 1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR Santa Ana CA 92702-1988 RE~TATIVES. AUTHOR~RESENT~l?E~. I I ,'c...te. y1 V\ - <.J ACORD 25 S (7/97) 11- 38 @ACORD CORPORATION 1988 ,tWl}-