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10/0/2004 10:30 AM FROM: Municipality Ins.5v Municipality Insurance Services, Inc. PAGE: 002 OF 005 <br />Municipality Sparta Quote# W-12675 <br />nsnrawe Serykes mosmassam <br />Larose, Jr. Joseph <br />J1999 Poinsettia Ave <br />Fountain Valley, CA 92708 <br />Date 10/8/2004 <br />Ne are able to offer the following teems which ere valid for 90 days <br />:everage SPARTA INSURANCE PROGRAM: Commercial General Liability - hazard 2 <br />Contract Value: $28,800 <br />Coverage Period: Anneal <br />Insurance Carrier Essex Insurance Company <br />Master Policy: 3CM4080 <br />Master Policy Effective Dste:11/15/2003 to expiration <br />limits $2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Complated operations / <br />$1,000,000 Personal & Advertising Isjury/$50,000 Fie Damage / Medical Payments Excluded <br />)edaetibles $500 BI & PD Per Claimant Including Loss Adjustment Expense <br />$950.00 Premium (Fully Earned) <br />$29.69 Taxes (SLA Taxes & Fees) <br />$50.00 Certificate Fee (Fully Earned) <br />TRIA <br />$1,029.69 Total Amount <br />•ems g 1. No Cancellations Allowed Premium, taxes and fees are fully earned at inception. <br />;owd(ams 2. Operations and Rating Based: The City desires to retain a consulteut having special skill and knowledge in the field <br />of recognizing and identifying narcotic related assess subject to forfeiture pursuant to state and federal asset forfeiture <br />laws. <br />3. Department: Sella Am Police Department <br />4. Additional Insured(s): Not Applicable <br />5. No Professional Liability Coverage provided <br />The Terrorise Risk Insuance AM of 2002, requires us to offer you a quote for terrorism coverage. This Quotation is <br />separate and not included in your coverage premium. This coverage must be accepted or rejected by you and the <br />attached form returned to us prior to binding. <br />dditfonal SANTA ANA (SPARTA) <br />aseed 20 Civic Center Plaza PO Box <br />isured: Santa Arm Ca 92701 <br />erasion Asbestos, Assault &. Battery, Employer Related Practices, Subsidence, Independent Contactors, Pollution, Cross Suit, Lead or <br />Silica Dust, Mold or Bio-cgenic Growth or Mildew, Punitive Damages, Animal, Breech of Contract, Y2K Electronic Data, <br />Medical Paymerrts, War or Terrorism. <br />The mausi rce provided under tins policy is limited to your work performed on behalf ofthe entity named as"Additional Named <br />Ins red" above and doesn't extend itself to any other work performed by you or your ogainzatan. Coverage b limited to the <br />description of opemtans and rating bases hated in "Temms & Conditions" itee 2. <br />Per the Master policy, a copy is available by wnitlen request to: Municipality Insurance Services, Inc., 302 W. Cerritos Ave., <br />Building 47, Anaheim, CA 92905 <br />302 W. Cmcitos Ave BIdgN 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-1100 fax (714) 687-1106 LicensesCA:0 04849; OR:195423 <br />Webatte address www.2spertacom <br />