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<br />EXHIBIT C
<br />(Continued)
<br />
<br />Sample Insurance Forms
<br />
<br />Sample Certificate of Liability Form
<br />
<br />ACOflD_
<br />PRCr.OC~~
<br />
<br />CERTU:;ICATEiOF LIABILITY INSURANC!:;,sR ~ ~"1.000Dm1
<br />.'._ '.,. . .,......._.,.. ,,' ""''-'..i',''':::''-,,_::::::,.,.:::::~.. ::":<,:,:,,,,;:,::-,,.::;.:':':',,-,,,:.::::i,,:,:,:,,:::::,::,::,:- .ii/.'::'>>--::':::::::-::-:':':>:-".':_":':' c,:-,,":""'''':'::':;:::''''':::::': "'. :::':' .. ,-:':. _ :..:;.::., ...:,:..-.~CO..:.l 11/12/97
<br />THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />COMPANIES AFFORDING COVERAGE
<br />
<br />Group, Inc.
<br />
<br />Insurance Services
<br />204 Cedar Street
<br />Cambridge NO 21613
<br />G. Philip Feldman
<br />PIlon. No" 410-229-6464
<br />INSURED
<br />
<br />F.. No.
<br />
<br />COMP"'NY
<br />A
<br />
<br />Federal Insurance Company
<br />
<br />COIAPANY
<br />e
<br />
<br />APR CONSULTING, INC.
<br />M:r;. Darryl stone
<br />22632 Golden Springs Dr., "'330
<br />Diamond Bar CA 91765
<br />
<br />COMPANY
<br />C
<br />
<br />,o.,,~
<br />o
<br />
<br />CO_V~fY'GJ;:$ '",________________ ___ ,', n+ ,\>:~?, "~ ,;
<br />THIS IS TO CERTIFY OOT THE POUClES'of: iNsURANC'i: LisTED'BEL.Ow HAVE BEEN ISSUfD TO"THE INSURED NAMED ABOVE FOR THE: POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUlRe.ENT, TERM OR CONOlTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THI!! WSURANC!! AfFORDED BY THe POlICIES C!!SCRIBED HEREIN IS SUBJECT TO All THE TERMS,
<br />EXCLUSIONS AND CONOlT1ONS OF SUCH POUClES.l1MfTS SHOWN MAY HAW BeEN REDUCED BY PAlO CLAIMS.
<br />
<br />'"
<br />m
<br />
<br />T'n'EQFINSURANCl!
<br />
<br />pOt.lCYNUMeB
<br />
<br />POLICYUFECTM! POLlCY EXPIRATION LIMITS
<br />OATE(MMIDOI'I'Y) OATE(MMlDO/YY)
<br /> GENEAAl. AGGReGATE S 2,000 000
<br />04!01!97 04!01!9. PROOVCT$. COMPIOP AGG S 2,000 000
<br /> PERSONAL & MJV INJl.IRV S1 000 000
<br /> EACH OCCURRENCE S1 000,000
<br />04/01/97 04!01!9. FIRE DAMAGE lAnr on.llf.j SIncluded
<br /> MED EXP (An~ on. ~l . 10 000
<br /> COMBINED SlNGLE llMfT . 1,000,000
<br /> BODILVINJURV .
<br /> {P..peISCIll!
<br />04!01!97 04!01!9. BOOllVINJURV .
<br /> (f'..llCcid...O
<br /> PROPERTYO"'M"'GE .
<br /> ...UTOOHt.V.E......CClOENT .
<br /> OTHERTHAN"'UWONLV;
<br /> EACH"'CC/OENT .
<br /> "'GGREG"'TE .
<br /> EACH OCCURRENCE .
<br /> AGGREGATE .
<br /> .
<br /> IfO'Ryl1~\'rs I 10Jjt ......
<br /> El. EACH ACCIDENT .
<br /> El. DISEASE . POI.lCV UMfT .
<br /> El OISEASE . EA eMPlOYEE .
<br />
<br />~ERAL UAIIlllTV
<br />A ~ ~ERCIAl GENERAL UAlIIUlY
<br />~_ ClAIMSM...oe ~ OCClIR
<br />'-2 OWNER'S & CONTR...CTOR"S PACT
<br />A X Computer Software
<br />" Sves E&O
<br />~OM08ILE LlABlUTY
<br />_ ANY "'UTO
<br />_ AlL OWNEl"'uros
<br />-=- SCHEDULED ...UTOS
<br />A ~ HIREOAVTOS
<br />~ NON.QWNEO...VTOS
<br />
<br />3532-61-16 CCG
<br />
<br />3532-61-16
<br />
<br />.1,000,000 CLADD wr.nz
<br />
<br />3532-61-16 CCG
<br />
<br />~~OELIABILlTY
<br />iAH'f"'UTO
<br />
<br />I
<br />
<br />EXCESS UABlUTY
<br />~:MBREL.LA FORM
<br />I ~THANUMBREU.A I'ORM
<br />WOAKERS COMPENSATION AND
<br />I!MPlOVERS'UA8lUTY
<br />
<br />THe PROPRIETORI
<br />PARTNERSlEXEClJTIVE
<br />Of'FlCERS"'RE:
<br />OTHEA
<br />
<br />R::
<br />
<br />oaCRIPTION 01' OPERATIONSo\.OCATIOHSNEtflCLESlSPEClAL ITEMS
<br />
<br />. ".
<br />
<br />SHOULDAN'( Ol" THI! ~ OESCRISED POLICIES SeCANCELLED BEFORE THE
<br />I!XJ'NlATION DATETHI!RI!O" THE ISSUING CClMl"AHV WILL MAIL
<br />~OAn WftlTTeH NOTICE TO 1lt!; Celml'lCATE HOLDER HAMEOTOTHE LEn,
<br />
<br />
<br />A""""'''''''.......''''..'''' g./~U. ~
<br />G. PhiliD. .~T ~AC~~o::::;.
<br />
<br />CITY OF SANTA ANA, ITS OFFICERS. AGENTS AND
<br />EMPLOYEES
<br />P.O. BOX 1988
<br />SANTA ANA, CA 92702
<br />
<br />.--.
<br />
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