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agSmIDl Municipality CtWet i'bf Y/[Jllt/ancet 11/22/2004 11:92 AM <br />001, <br />Sparta Program 4 - aooA�1_ 195 <br />�__;x;a _ _.... �aa:reare ri e{ana_re �rre:��>� _ _ _ � ±:+:a ?q.. ..y...� n. , e�.•.>Esaaax� eaaaiaaErerreeaa avF x re _ �. :a::as . ... x-x.... .. K;:��: <br />Vame Insured: Named Additional Insured: <br />3arrett, Ronald <br />?5551 La Mirada Street <br />,aguna Hills, CA 92653 <br />certificate # <br />-'overage <br />I ,units <br />I )eductibles <br />Perms & <br />conditions <br />exclusions <br />SSA04-0026 <br />SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br />SPARTA INSURANCE PROGRAM: Commercial General Liability - Hazard 2 <br />Contract Value: $72,000.00 <br />Coverage Period: 11 A 9/2004 to I I/19/2005 <br />Insurance Carrier: Essex Insurance Company <br />Master Policy: 3CP9777 <br />Master Policy Effective Date: 11 /15/2004 to expiration <br />$2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Completed operations / <br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage / Medical Payments Excluded / <br />$500 BI & PD Per Claimant Including Loss Adjustment Expense <br />$950.00 Premium (Fully Earned) <br />$29.69 Taxes (Fully Earned) <br />$50.00 Certificate Fee (Fully Earned) <br />TRIA <br />$1,029.69 Total Amount <br />1. No Cancellations Allowed. Premium, taxes and fees are fully earned at inception. <br />2. Operations and Rating Based: Consultant - Manage City of Santa Ana traffic signal control system while city <br />completes a hiring process. Will be training new city employees on the system field investigating traffic signal <br />operations and implement traffic signal timing data <br />3. Department: of Public Works / <br />4. Additional Insured(s): Not Applicable <br />5. NO PROFESSIONAL LIABILITY COVERAGE PROVIDED. <br />Asbestos, Assault & Battery, Employer Related Practices, Subsidence, Independent Contractors, Pollution, Cross Suit, <br />Lead or Silica Dust, Mold or Bio-organic Growth or Mildew, Punitive Damages, Animal, Breach of Contract, Y2K <br />Electronic Data, Medical Payments, War or Terrorism. <br />The insurance provided under this policy is limited to your work performed on behalf of the entity named as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or your organization. <br />Coverage is limited to the description of operations and rating bases listed in "Terms & Conditions" item 2. <br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, Inc., 302 W. Cerritos <br />Ave., Building 07, Anaheim, CA 92805 <br />Carol Frost / President <br />Municipality Insurance Services, Inc. <br />f315fi:ca39:L9.°J959Ci i' e.:9S°Gti:oL^eaiauaeA:::C:f39:IR°biaaa:a::a::�m:f3:C ]1&{li4 a.aa..._._ _..A.k.fi°fa°a .e.._.._._ F1 3 m..�. _.. .:.}{..rem ..-...e.. 'i °oo mneev.va::a <br />302 W. Cerritos Ave Bldgtt 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-1100 fax (714) 687-1106 LicensesCA:0004849; OR:195423 <br />Website address www.2sparm.com <br />