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08/02/2005 09:20 19493056166 <br />COLONIAL PRA <br />PAGE 01/02 <br />.9~.Oe4N CERTIFICATE OF LIABILITY INSURANCE °"'~'M~°°"Y"" <br />os/ol/zoos <br />PaowDrn (94g);OS-6161 FAX (949) 305-6166 THIS CERTIFICATE IS 133UED AS A MATTER OF INFORMATION <br />Colani al Nestern Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />26691 Plaza Drive, Suite 220 HOLDER.THISCERTIFICATEDOESNOTAMEND,EXTENDOR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />~ Mission Viejo, CA 9[691 <br />INSURERS AFFORDING COVERAGE NAIC M <br />i w3uREB Correct ono Managed Care Me xa arpordtion INBURZR A: Lexington Insurance C an <br />4211 E. La Palllcel Ave. INSURER B: St. Paul Travelers Ins. Co. <br />Anaheim, CA 92807 INSUR~RC: <br />INBUa$a DI <br />INSVRER E: <br />1 ne wu uuc, ur IrvauNArvct usTED BE LOW NAVE BEEN ISSUED TD THE I NSURED NAMED A BOVE FOR THE PO LICY PERIOD INDICATED. NOTWITHSTANDING <br />A NY R EgUIREMENT, TERM OR CONDITIO N OF ANY CONTRACTOR OTHER DOCUMENT WITH R ESPECT Tq WHIC H THIS CERTIFICATE MAY BE ISSUED OR <br />M AY P ERTAIN, THE INSURANCE AFFORDE D SYTHE FOLIGIES DESCRIBED HEREIN IS SUBJEC T TO PLL THE TER MS <br />ExCLUSION3 ANO CONDITIONS OP SUCH <br />P OUCI 63. AGGREGATE LIMBS SWOWN M AY HAVE BEEN REDUCED BY PAID GlAIM3. , <br />INSR TYPE Of INSURANCE PoLM:Y NUMBER POLICYE FICTIVE PQLM:Y F]IPIRAl10N UMR9 <br /> GENBRAL LUUBUIY D114761 D8/Dl/2005 D$/Ol/20D EACH OCCURRENCE f 10001000 <br /> X COMMCnCIAL CENEn/IL IIaMLRV DAMAQP, TQ RF.'PJ'IEP <br />E S~ DO <br /> F1AIyF?•{ka•ONWM <br /> X CLAIMS MADE n OCCUR MEP EJ(P <br /> IAaY one Person) E 5 , 00 <br />A PER80NALQADVIWURY E 1 <br />000 <br />00 <br /> , <br />, <br /> l ENERAL AGOREOaTE 5 3 <br />000 000 <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO , <br />S 1 000 OD <br /> POLICY JECT LOC <br /> AUTOMOBILE LIABIDTY RX02071644 D2/D4/2D05 D2/D4/2006 <br /> <br />arvr auto COMBINE091NGLE LIMB <br />~1 eEtl°°nll _ <br />S 1000 000 <br /> 411. OWNFn 411T(i5 <br /> <br />g SCHEDULEP AUTOS DM~r ll.v iwunv <br />I P°'°'1 E <br /> X HIRED AUTOS -' <br /> <br />)( <br />rnurv•uwneu au lua SOFTLY INJURY <br />(pw acddnnll <br />f <br /> <br /> PROPERTY DAMAGE E <br />__ (PxeCCIUeMI <br /> GARAGE lM181LRY AUlOONLY-EA ACCIDENT S <br /> ANV AUTO <br />OTHER THAN EAACC <br />S <br /> AUTO ONLY: AGG f <br /> E%CEB&UMBRELLA LLIBIUTY EACH OCCURRENCE E <br /> <br /> OCCUR ~CUIMB NAOE A17 ~JRQ'~7 ~1~ ~~S 1(~ j'~lZ~ AGGREGATE P <br /> E <br /> OEOUCTIBLE ~` <br /> RETENTION f - - ~__.. <br /> - 8 <br /> WORNERB COMPEN8A710NAND ,H Ca - 1 ~- ' we arnTlF OTrv <br /> ELIPLOYEIIS' LIABR.ITY . TORV.LIMttB. <br />~ <br /> , <br />Sti15 NUI Lily hli~: nJt <br /> ANY PROPRIE-fOfiIPARSNER1OfECUTIVE <br />OFFICEg EL. EACH ACCICE'NT S <br /> MIEMBER E%CLUDEV! <br />Il yee Ee9CllbeuMK <br />EL OISEASE•EA EMPLO <br />S <br /> SPECIAL PROVISIONS EebW E.L. OISEASE•POLICV UMR S <br /> ro"~essionai Liability 0314761 08/01/2005 08/01/2006 ProF Liability: Slmil/f3mi1 <br />A anaged Care EdA Liab <br />. 0314761 D8/0 <br />1 <br />/ <br />2 <br />005 08/01/2006 Managad tarn E81D: 41M17/13Bri1 <br />~ <br />gp <br />$ <br />L p[ <br />9 <br />pE <br />C <br />1 <br />pL MiON1810Ne <br />10f Gays notice o~`ca^cellal7~Wllf or n0~„ pavRlCnt o~E <br />`~' <br />' <br />pf <br />e <br />mi plll <br />ertificate Holder is an Additional insured for general liability and professional liability per <br />indorsem <br />t N14 <br />d <br />en <br />attache <br />. <br />City of Santa Ana <br />Santa Ana City ]ail <br />Attention: Chris Laugedaur, Contracts <br />62 Civic Center Plaza <br />Santa Ana, CA 92702 <br />BNOULB ANY OF THE ABOVE OESCRIBEO POLw1E9 Bfi CANCELLED BEFORE THE <br />E%PIRATNNi GATE THEREOF, THE 169UINO INSURER WILL BNOEAV00. TO MAIL <br />b3~ DAIBWWITRN NOTICE TO THE GF.BTIFlCBR NOI-lR NaMlDN THE OBIT, <br />BUT FAR.VRE TO MAIL SUCH NOTICE SHALL IMP08E NOOBUOATNIN OR LUIBILRY <br />ACORD 45 (4007!08) \~ f t ~ ~ Z ~ S _ _ ~j ~ ~ f <br />®ACORD CORPORATION 1988 <br />OroYldu COYeTM}fIP ~,.•••••o -- <br />