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1,~~6'l""~ "'"'" .........,.......""'... ..~O" -. -.. ," ACORD~ CERTIFICATE OF LIABILITY INSURANCEpag< 1 of 2 I DATE 06/03/2004 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis North America, Inc. - Req~onal Cert Center HOLDER. TH)S CERTIFICATE DOES NOT AMEND. EXTEND OR 26 Cent.ury Blvd. ALTER TH E COVERAGE AFFOROED BY THE POLICIES BELOW. F. o. Box 305191 Nashville, 'TN 31230.51 n INSURERS AFFORDING COVERAGE INSURED ~etra ~edh, 7nc. (ISG) A,~orA-07f 11lSlJRERA Hartford Fire 7nlilurance Company 19682-001 11710 Car':.vright Rd. Ste. 500 INSURE.R 6 Hartford Casualtv 7nsurance Comnanv 29424-001 Irvine, a '2614-5850 INSURERC: ACE ).merican Insurance Corn. L"'I.V 22661-011 lrlSURERO ArrIericllrI Internat.ional Soecialty Line:!! In 26883-000 , ItlSURERE COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDlCATED. NOrwITHSTAi'llDING ANY AEOUIRE,\lENT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY t-lAVE BEEN REDUCED BY PAID CLAIMS INSR TYPECFINSURANCE I POLICYNUMBEA PJlAL+~1J~f88;W; i P8i~C.r~~bR~~~qN! LIMTS LTR; A I CENERAL "A"UTY 172 UUN UM0820 10/1/2003 10/1/2004 E.ACHOCCURRENCE I. 1 000 000 Pi CO"","CML CEN,"AL UAlllLfTY . FIRE DAMAGE iA.~yOl"e ~..e' I. 300 000 I I ClAlJ.tSMADE [i] OCCUR MEDEXP(A~yO'"e :;lO/"$0I"1 I. 10 000 Wcontract I.iab PERSQrJAl Eo ADvmJURY I. 1 000 000 ~x.c.u Covenoe I GENERAL AGGREGATE I. 2 000 000 GE~rlAGGREaATE LIMIT APPlIESPfR I" PRODUCTS. COMP{)P AGe I. I I POllCy!;l ~T n LOG I I A ~_."_.., 72 UEN UM0844 10/1/2003 10/1/2004 I CQ.tBltlED SINGLE lIMI r I. /.flY AUTO (E:aacc'cl!~:l 1,000,000 X ALL ONNEDAUTOS BOOIL Y INJURY I SCHE.OUL~DAUTOS (Pi!"pl!'J.O~: :5 x HIREDAUTOS i BOOIL Y ltJJUR'l' , (///; J, " I. R ''''NO'~'EOAUIOS I tl-'e'ilccce-:) I rf0->t02fZ{tj //2 I PROPERTY DAMAGE I I (Pe'ilu;;ce~:; I' ~RAGE LIA61UTY I V I I AUTomll'l'. EAACCIDENT I. HArtfAUTO I OTHER THMI EAACC 15 . I , AUToom Y AGG; 5 B ~ESSLIA8ILITY 172 XHU UH0346 10/1/2003 10/1/2004 I EACHOCCURRE11CE I. 10 000 000 " 0 I ACGFlECATE I. 10 000 000 I X : OCCUR ClAJMS MADE r r I, n DEDUCTletE I I I. IIRETENTlOI'I , , , " C WORKERS CO~~ENSATION AND IWLR C4397l31-1 1/1/2004 10/1/2004 Ix I T~~~!~JNs! ;oJ~.1 EM?lOYERS' LIABILITY 000 E.L.EACHACCIDBH 1$ 1 000 l i E.l. DISEASE. EA EMPL.OYEE: 5 1 000 000 !E.L.OISEASf..POlICYlIMIT Is , nM - n-no 0 IOTHEA 11952583 10/1/2003 i 10/1/2004 1$5,000,000 Each Claim Pro!e.ssi.onal I $5,000,000 Aqqreqate pollution/E""O Legal ]..i~. i$ 25~~OOO Rentention Clai.m I :~- ;-" "".inn -,. DESCRIPTION OF O~ERATIONSllOCA TIONSIVEH1ClESIEXCLUS10NS ADDEO BY ENDORSEM E~TISPEC1AL PROVISIONS RE: Elevated 7ank ~mprovements city of Santa Anat it~ offic::er~t employees, agents, volunteers and representatives are included as Additional Insured with respects to General Liability as required by contract. CERTIFICATE HOLDER I X I AODITlONAL INSUREO, INSURER lETTER CANCELLATION City of Santa Ana Public Works Agency 10 Civic Center P~a%& RO:JS Ar~"'I.ex San~a k,a, CA 92701 ACORD 25-5 (7/97) ":)";-C') C' ',1j D f1- r~, l-L I: ""S SHOULD ANY OFTl-!E ABOVE DESCRIBEu ~OLICICS BE CANCELLED BEFORE THE. EX~tR.\T101ll DATE. THEREOF. THE ISSUINC INSURER WILL ~."'A1L ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NA....=.OTO THE LEF"C{~L =""""""lQOO(=~OG( AUTHORI l:. .-0,- Coll:1009493 7pl:247939 Cert:4438444 J ~