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Certificate of Insurance
<br />1 of 1 il82035
<br />COVERAGES: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LIS It U atLUW Nnvt rsttn moo to
<br />NnTWITHRTANrM ANY RFOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
<br />OAY PERTAIN.
<br />TYPE OF INSURANCE
<br />BY THE POLICIES UESCHItltU
<br />POLICY NUMBER EFF.DATE EXP.DATE
<br />A
<br />GENERAL LIABILITY
<br />Agency Name and Address:
<br />Professional Practice
<br />Insurance Brokers, Inc.
<br />2030 Main Street, Suite 350
<br />- --Irvine,-CA-92614-7248
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF
<br />INFORMATION ONLY AND CONFERS NO RIGHTS UPON
<br />THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
<br />NOT AMEND, EXTEND OR ALTER THE COVERAGE
<br />AFFORDED TRE POLICIES LISTED -BELOW.
<br />09/01/05
<br />$2,000,000
<br />Com anies Affording Policies:
<br />A. United States Fidelity & Guaranty Co
<br />B. St. Paul Fire & Marine Insurance Co.
<br />C.Continental Casualty Company
<br />D.
<br />E.
<br />F.
<br />Insureds Name and Address:
<br />Dahl Taylor &Associates, Inc.
<br />Y
<br />2960 Daimler Street
<br />Santa Ana, CA 92705-5824
<br />Each Occurrence:
<br />$1,000,000
<br />COVERAGES: THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LIS It U atLUW Nnvt rsttn moo to
<br />NnTWITHRTANrM ANY RFOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
<br />OAY PERTAIN.
<br />TYPE OF INSURANCE
<br />BY THE POLICIES UESCHItltU
<br />POLICY NUMBER EFF.DATE EXP.DATE
<br />A
<br />GENERAL LIABILITY
<br />BKO1885006
<br />09/01/04
<br />09/01/05
<br />$2,000,000
<br />Commercial General Liability
<br />$1,000,000
<br />Each Occurrence:
<br />$1,000,000
<br />Fire Ding. (any one fire):
<br />❑ Claims Made
<br />Combined Single Limit:
<br />$1,000,000
<br />Bodily Injury/person:
<br />$0
<br />® Occurrence
<br />$0
<br />Property Damage:
<br />$0
<br />Each Occurrence:
<br />❑ Owner's and Contractors
<br />Aggregate:
<br />$1,000,000
<br />Statutory Limits
<br />Protective
<br />$1,000,000
<br />Disease/Policy Limit:
<br />$1,000,000
<br />Disease/Employee:
<br />El
<br />Per Claim
<br />$1,000,000
<br />Aggregate
<br />A
<br />AUTO LIABILITY
<br />BKO1885006
<br />09/01/04
<br />09/01/05
<br />❑ Any Automobile
<br />LJ All Owned Autos
<br />❑ Scheduled Autos
<br />APPROVED
<br />A5 TO
<br />FORM
<br />Hired Autos
<br />Non -owned Autos
<br />l
<br />❑ Garage Liability
<br />out
<br />$Litt oed
<br />❑Assistatt
<br />C' Attor
<br />e
<br />A
<br />EXCESS LIABILITY
<br />BKO1885006
<br />09 1/04
<br />09/01/05
<br />❑X Umbrella Form
<br />❑ Other than Umbrella Form
<br />i3
<br />WORKERS'
<br />BWO1878414
<br />09/01/04
<br />09/01/05
<br />COMPENSATION
<br />AND EMPLOYER'S
<br />LIABILITY
<br />C
<br />PROFESSIONAL
<br />AEA113969319
<br />05/06/04
<br />05/06/05
<br />LIABILITY'
<br />POLICY LIMITS
<br />General Aggregate:
<br />$2,000,000
<br />Products-Com/Ops
<br />Aggregate:
<br />$2,000,000
<br />Personal and Adv. Injury:
<br />$1,000,000
<br />Each Occurrence:
<br />$1,000,000
<br />Fire Ding. (any one fire):
<br />$500,000
<br />Combined Single Limit:
<br />$1,000,000
<br />Bodily Injury/person:
<br />$0
<br />Bodily Injury/accident:
<br />$0
<br />Property Damage:
<br />$0
<br />Each Occurrence:
<br />$1,000,000
<br />Aggregate:
<br />$1,000,000
<br />Statutory Limits
<br />Each Accident:
<br />$1,000,000
<br />Disease/Policy Limit:
<br />$1,000,000
<br />Disease/Employee:
<br />$1,000,000
<br />Per Claim
<br />$1,000,000
<br />Aggregate
<br />$1,000,000
<br />$0
<br />Description of Operations/Locations/Vehicles/Restrictions/Special items:
<br />GENERAL LIABILITY: THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED ADDITIONAL INSURED
<br />PER ATTACHED ENDORSEMENT.
<br />Certificate Holder:
<br />City of Santa Ana
<br />Attn: William Watson
<br />Fire Dept.
<br />1439 So. Broadway
<br />Santa Ana, CA 92707
<br />cc'
<br />THE AGGREGATE LIMIT IS THE TOTAL INSURANCE AVAILABLE FOR CLAIMS PRESENTED
<br />WITHIN THE POLICY FOR ALL OPERATIONS OF THE INSURED.
<br />CANCELLATION:
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING COMPANY, ITS AGENTS OR REPRESENTATIVES WILL MAIL 30
<br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EXCEPT IN
<br />THE EVENT OF CANCELLATION FOR NON-PAYMENT OF PREMIUM IN WHICH CASE 10 DAYS
<br />NOTICE WILL BE GIVEN.
<br />Authon"d Representative'. /y /11 08/20/04
<br />
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