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Sep 11 07 11:42a A Public Works 7146473345 p. leis cec ir—fc ns executed by Liberty Mutual Insurance Group as respects sucb nmSUramce as ha afforded by durse eompanres. BMO%s Certificate of Insurance phis cemficue is issued as a owner of hilly nation only and coolers no rights upon you the certificate holder. -nus cemficatt is not an insurance policy and does not amend, extend, or alter die coverage afforded by tht politic listed below, __ _ ____ _ Policy Term This is to certify that (Name and address of Insured) 10� W00fASTVI AKIIORISIS,INC 2200 EAST VIA BURTON ` i L / ANAHEIM, CA 92806 A -.2 O4 LI —� I b 1Viutum'. is. at We issue date of this certificate, utsn i) not altered by aov ieouir enicut. tent/ or Expiration Type Continuous' Extended X Policy Term Workers Compe.ps fio i General Liability Claims Made X Occurrence 7 Retro Date Automobile Liability X Owned X Non -Owned X Hired I by the t„ ompa y under the poacy(tes) listed below. The utsura ice afforded by the listed policy(tes) is subject to all their terms, exclusions and conditions and ildition of any contract or other doctnxty with respect to which this certificate may be issued. Eff lEx . Dates Policy Number (s) Limits of Liability 04/01/200710410112008 WA2 -16D. 039499 -067 Coverage afforded under WC law of Employers Liability the following states. Bodily Injury By Accident CA $1,000,000 Each Accident Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1,000,000 Each Person 04/0112007/04/0112008 TB2 -1 6 1 - 039499 -01 7 I General Aggregate-Other than Prod/Completed Operations Products /Completed Operations Aggregate Bodily Injury and Property Damage Liability Per $1,000,000 Occurrence Personal and Advertising Injury Per Person / $1,000,000 Or anizatioi Other Liability Other Liability $100,000 Fire Legal Liability J$5,000 Medical Payment 04,'0112007104/0112008 AS7 -161 -039499 -037 Each Accident - Single Limit - B. I- and P. D. Combined $1,000,000 Each Person Each Accident or Occurrence Each Accident or Occurrence Equipment Floater 04/01/2007104/01 /2008 YM2 -161 -039499 -057 Package Property 04/0112007/04/01 /2008 YY2- 161 -039499 -027 C Additional Insured- City of Santa Ana, its officers, employees, agents, volunteers and representatives, on the General Liability policy listed above (per attached LG 1016 O endorsement). This insurance is primary and non - contributory for those losses due to the sole negligence of the named insured (per LG 1016). M M E N T S 'i f au cemtncate exprranon dale is continuous or extended term, you will be nolifled if coverage d terminated or reduced berort the certificate expiration date. However, you will not be monied annually of the conumuuon of covcmge Special Notice - Ohio: Any person who, wiW intend to defraud or luhowing that he/ skis facilitating a flaud against an insurer. submits art application or fries a cPaim containing a false or deceptive staitment is suilty orinsurarsm Gaud important (nformauon to Florida policyholders and certificate holders: in the event you have my questions or need information about Ibis certificate for any teum. please contact your local sales producer. whose mane and telepttonc number appears in the lower IM domC of li•.is urtifiWne. The appropriate local sales orrice mailing address may also be obtained by callus this number FL Rtglsterea f. mmnterual Vehicles: AT provided for in section ?Z0 OZ (5) (E) TL State, the listed insurance policy may not be cancelled on less than 30 days written notice by the insurer to the Department ofNwy Safety & Motor Vehicles, such 30 days notice to comhnencc from date notice is reec. —d by the Department cc or canceumon. 'tot appocao,c umess a miniver m days ns entereo below) Boone the stated expnalt— dale the company will not cued or reduce the insurance atTorded under the above policies until at lease 30 days witce of such cancellation has been mailed to Office: PLEASANTON, CA Phone: 800 - 343 -1534 Certificate Holder: City of Santa Ana Public Works Agency M85 220 Sout^ Daisy Avenue Building -A Santa Ara, CA 92703 e J rf KALEEN OSENDORF Date Issued. 04/03/2007 Prepared By: DH