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'aftmHll Municipality I'r1hWtLeAd'bf YftW&ancet 5/13/2005 4:47 PM <br />Sparta Program <br />�r�,rrsu�n�n��sirn���a�xTnnaamar�nunx�aa�ninn�nrninu�nnnier�innrn�rem�nrnni�nnn�nenntxnxnnn�nr�naara�mw�xmunwwnnni��sm�oaan�mi <br />Name Insured: Named Additional Insured: <br />Larosa, Jr. Joseph <br />91999 Poinsettia Ave <br />Fountain Valley, CA 92708 <br />Certificate # SSA03-0024 <br />A- --) c c, i — �� � �- SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br />Coverage SPARTA TNSURANGR PROGRAM. Commercial General Liability - Hazard 2 <br />Contract Value: 528,800.00 <br />Coverage Period: 10/8/2004 to 10/8/2005 <br />Insurance Carrier: Essex Insurance Company <br />Master Policy: 3CM4080 <br />Vaster Policy Effective Date:l 1 / 1 5/2003 to expiration <br />Limits $2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Ccmplcted operations / <br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage / Medical Payments Excluded <br />Deductibles $500 RT & PT) Per Claimam Tnchrding Toss Adjustment Expense <br />$950.00 Premium (Fully Earned) <br />$29.69 Taxes (Fully Earned) <br />$50.00 Certificate Fee (Fully Earned) <br />TRIP. <br />$1,029.69 Total Amount <br />Terms & 1, No Cancellations Allowed. Premium, taxes and fees are fully earned at inception. <br />Conditions 2. Operations grid Rating Based. The City desires Lo retain a consultant laving special skill and knowledge in die field <br />of recognizing and identifying narcotic related assess subject to forfeiture pursuant to state and federal asset forfeiture <br />laws. <br />3. Department: Santa Ana Police Department <br />4. Additional Insured(s): Not Applicable <br />5. No Professional Liability Coverage provided. <br />Exclusions 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, Wm or Terrorism. <br />The insurance provided under this policy is limited to your work performed on behalf of the entity [tamed as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or your organization. <br />Coverage is linnited to the description of operations and rating bases listed in "Terms &, Conditions" item 2. <br />Par the Master policy, a copy is available by written rcquast to: Municipality Insurance Services, Inc., 302 W. Cerritos <br />Ave., Building #7, Anaheim, CA 92805 <br />APPROVED AS TO FORM <br />{ <br />Laura 5t!i! Sh cdy <br />Assistant City Attorney <br />Carol Frost i President <br />Municipality Insurance Services, Inc <br />nemmmmeieeenmssmmmwunmimmnnneimnaunnmeo�einnmeanxnnnmmennmm�xumnnmmninnnm�smnm:maeonnnnrmnrznwaenuoc:�mminnraennimmnnesonnnnminNnienuisimnmannui�nnn�runn� <br />302 W. Cerritos Ave Bldg# 7 Anaheim, CA 92805 (800) 420-0555 (714) 667-1100 fax (714) 687-1106 LicensesCA:0004849; ORA 95423 <br />Website address www 2sparta. corn <br />