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<br />THIS CERTIFICATETE IS RSSUEO AS A MATTER OF INFORMATION
<br />RTI
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />Aadseini & Company
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />300 Esplanade, Suite 100
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />COMPANIES AFFORDINq COVERAGE
<br />Oxnard, CA 93030
<br />(805)981-9585 F:(805)981-0161
<br />COMPANY
<br />PHILADELPHIAINDMINITY INS_ CO
<br />COMPANY
<br />NEIIRFA /I� 1wq -I ROT
<br />ORANGE COUNTY CONSERVATION A-Aocot-147
<br />STATE COMPENSATION_ INS•. FUND
<br />CORPS FAX NO. 1(714)-956-1944
<br />A-)003-Z3
<br />_..,e..,._-.
<br />COMPANY �I
<br />700 N. VALLEY STREET, STE. AB
<br />92801
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<br />ANAHEIM CA
<br />COMPANY...
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<br />THIS 15 TO CEHNFY THAT THE POLICIES OF INSURANCE USTtD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTf IER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CLHIIFICATE MAY BE ISSUED OR MAY PERTNN, THE INSURANCE AFFORDED BY DIE POLICIES DESCRIBED HEREIN IS SUBRECT 10 ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY IIAVE BEEN REDUCED BY PAID CLAIMS.
<br />^.. -.".POLICY
<br />FRFCTTYC POLMOY NATION tam
<br />TYPE OF INSURANCE POLICY muI
<br />TR- I DATE (MI DATE PE DIM"
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<br />OrNEAAL LIANFm
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<br />0 7 / 2 0 / 0 4
<br />07 / 2 0 / 0 5
<br />CENERA AOOHEOATE , , . ,,
<br />A2400,00D._.—
<br />COMMERCIAL OENEPoLLL�MjLITY
<br />FRONT n ; CMR!1 ±O�
<br />a,Z,BBO,BBD
<br />CLAIMS MADE Gil OCCUR
<br />PUQCNAL b ADY HA1R'Y
<br />EACHOCCURRENCE...
<br />—_ OWNM'SbCONTRACTORSPROT
<br />51,000,000._.____
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<br />FIRE DAMASE (Any R'MI NF)
<br />a 00,OII0
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<br />NEDW Wtl am FaroNN
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<br />A
<br />ALrroMD11RZ
<br />LIABARY
<br />PHPKOM20
<br />07/20/04
<br />07/20/05
<br />OOMOINCD SINGLE LIMIT
<br />41,0ENI' 0
<br />ANY AUIO
<br />.............. —_
<br />a
<br />ALL OWNED AUTOS
<br />BOOZY INJURY
<br />SCNCOULCD AUTOS
<br />(Par Prma)
<br />HIRLO ALICE
<br />BODILY NMTY
<br />a
<br />NON-OYMFO AUTOS
<br />For IwIdua5
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<br />PROPERTY DAMAGE
<br />a
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<br />UAA0E 14JU1FITY
<br />ANY AUTO
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<br />EACH OCCUMMCE
<br />11
<br />AODREdTIE
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<br />UMRRRLAFDRM
<br />nc$1$ta
<br />OTM01 THAN UMIIHELLA FORM
<br />f
<br />B
<br />RS COMPENSATION AND
<br />WORKERS COMPENSATION
<br />ee1OEA7-04 0
<br />07/O1/04
<br />07/O1/05
<br />-SLIM nIN-
<br />X A.i
<br />71.000,000'. ._. -._
<br />d EACH ACCIDECIU9NT
<br />_--.
<br />EL DISEASE - POLICY �N1R
<br />. _
<br />THS PHOPHIEIOR/ INCH.
<br />a.1,B00.ODD—
<br />PA TNERS,EN:CUTNE
<br />OFFICERS ARF.: IXCL
<br />_... . ..
<br />EL DISEASE . CA CMPLOYIE
<br />a
<br />OTHER
<br />A
<br />AUTO PHYSICAL
<br />PHPKOISM
<br />07/20/04
<br />07/201/05
<br />DEDUCTIBLE 1,000 COMP
<br />DAMAGE
<br />DEDUCTIBLE 11000 COLL
<br />DUC-PTKIN OF ORRArMWLOCATDPUMIIIOLEE MCIM IT=
<br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED
<br />ADDITIONAL INSUREDS PER FORM CG 20 26 11 85, ATTACHED WITH RESPECT
<br />TO THE OPERATIONS OF THE NAMED INSURED.*EXHIBIT B, ALSO ATTACHED.
<br />*10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMQIUM SHALL APPLY.
<br />Ciit,..... H •O11Rk
<br />#Y:W','•.:t^iR`X. ~'nivTPInSi s.:.'i •''e n 3x4'RE.+R"
<br />.._.,.� P,'u{%,4°#Y
<br />EMERALD ANY OF THE ABOVE INO ROW POMIOIF$ BE CANCaMM'D BEFORE THE
<br />SANTA ANA WORKFORCE INVESTMENT HOARD
<br />EXPIRATION DATE TrERwP, THE MEANO CERYANY wu)0ft"*KYA MAIL
<br />ATTENTION: FRAN JUTZI
<br />530 DAYS WADTFD NONCE TO ME CPRTRCATE HOLLIFR NAMED TO THE LEFT.
<br />1000 E. SANTA ANA BLVD., #200
<br />q6x?FMUCroxfticNwXltaaLaYlEarsEMXWYnMdlol NafoawcYAftlMIKiRV(
<br />SANTA ANA CA 92701
<br />OFX)1IDP )10101 )EMMXIh)uL7f71MLM0()ONIf X)AMMiYMN116i1i1(
<br />AM
<br />FAX: 1/714)565-2602.:WED
<br />10 'd 'ON XVJ Wd 9V:10 03M b00d-H-100
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