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<br />CO.."MES""_CCIIIEIIAOE
<br />COM>ANV E; ..._U......_ 1_"". CD.
<br />
<br />Moron, lnC.
<br />1111I A...... "''''''_.
<br />New Vorl<, NY 10031
<br />Tol8p11on. (212) 34&-5000
<br />
<br />COYPAIIlY F: New V_...._ " _'" .......... Co. (IM<I)
<br />
<br />INaUAED
<br />
<br />COMPANY G: N___ NU_ CoOlll""Y
<br />
<br />Slmpl8xGrlnllen. LP
<br />1101 WEST SEQUOIA AVE
<br />OAAI\IGE. CA Il288ll
<br />l,JnAed Stetes.
<br />
<br />COMPANYH: ____eo,
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<br />NORKERS COMPSN~~TtON POLICIES
<br />
<br />carrier
<br />(S) A1ftl!tt:i,~Aft 'Holle Assurance CQ.
<br />IE) Na~ional union ri~~ lft~u~aftce CO.
<br />(D) I~surance compan~ Q{ ~h~ S~a~e of PA
<br />(C) Illinois N.tiQn~l Iftlurance Co.
<br />IC) Illinoi. N,~io~al Insurance Co-
<br />(A) hI Sottth Insurance eQ.
<br />[El American flame A$$,,,:llnce Co.
<br />
<br />~oUcy Number
<br />P.MIte58!Ui7U
<br />:J:tMli'CSS91!l1S1
<br />l\MNCS89a78S
<br />R!1IIcS99S7eg
<br />P.f9rc5S9S790
<br />'p'~C589 8 '7 91
<br />RMHcs896'i'92
<br />
<br />Rtf. Da~e
<br />10/1/2004
<br />'0/11200'
<br />10/1I200Jl
<br />lD/1/2004
<br />'0/1/2001
<br />10/1/20Q4
<br />1tI/J,/2004
<br />
<br />txp. C;llt~
<br />lOl2l200S
<br />10/~n.005
<br />10/1/2005
<br />10/1/2005
<br />10/217.00'
<br />10/1/2005
<br />10/1/200S
<br />
<br />S~at:e
<br />CA
<br />NV, OR
<br />1\.R, fi. MAr tN, VA
<br />It. MI
<br />NY, tH
<br />G~
<br />^l~ O~her S~at~A
<br />
<br />t,IA.1UUTY PROGMM
<br />Cer~itlca~e hQld~~ 4n~ any pa~~i@s li~t~d ~lov are adde4 a$ ~n ndditional insured for ~n~ral Liabili~y and ~utc
<br />1i~biliey. but Oft11 ~o the e~t~ft~ of ~he N~ed tn$u~~d'~ ncgliqence.
<br />
<br />The Named Insured. 0),"0 vaives: 1't.8 riqhl: of !;ubrogatioft in tayor Qf c~~;ifie:at.C! bolder and. t;h~ phrtie!!: l1s~ed below
<br />with re3pge~ ~o General Liahili~y, ~u~o L1&bil1~y. Worker$ C~~ft~ation.
<br />
<br />The insurance will b~ 9~imary antt non-cone~jbu~ory. ~i't.h reapecl: l:Q a~y ~th~E insurance carT.~~rl by the cer~ificate
<br />hold.I;>'C, bl,tt Oftty to dle ex'teDt; of i:'.h4' NJUfte-~ Insured's ner;rliljl'e"e~.
<br />
<br />Addit;ional Insureds~ SAN~^ hNh POLICE DEPARrMtN~. CITY OF SANTA ANA
<br />
<br />PrQj@cr,: GANTA ^N~ POLICE DEPAR1Mr.N~
<br />
<br />It t;her~ is ~ qac~tio~ rega~din~ t;hi3 ~~~tifiea~o pleaBe cont;ac't ttOA TORRES
<br />(!~il: BLTORa~S@TYCOINT.ODM Phone~ 71~-g7D-lalQ)
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<br />SANTA A"'A POLICE DEPARTMENT
<br />sa CMC C~TER PLAZA
<br />SANTA ANA, 921'0
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