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<br />:om Municipality <br /> <br />In~ ~-7~ \7~11 at 8/28/2003 3:2~ <br />CerÜjICaCe OJ .InSUrance <br />Sparta Program <br /> <br />002/002 <br />').COJ. ) '¡; :.:: <br /> <br />"M <br /> <br />! <br />¡me Insured: <br />mas, Abel <br />Antibes <br />~ Nigue1, CA 92677 <br /> <br />!rtificate# <br /> <br />lVerage <br /> <br />nUts <br /> <br />.dumbles <br /> <br />~rms & <br />mditions <br /> <br />(elusions <br /> <br />Named Additional Insured: <br />SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br /> <br />SSA02..o016 <br /> <br />SPARTA INSURANCE PROGRAM: Commercial General Liability.. Hazard I <br />Contract Value: $20,000.00 <br />Coverage Period: to <br />Insurance Carrier: Essex Insurance Company <br />Master Policy: 3CJ8801 <br />Master Policy Effective Date: 11115/2002 to expiration <br /> <br />81;1.'1103 - 8"1,;l.'110+ -Uh f2.~ItFlbra-Rid<.~) <br />8 ~.,)~O3 <br /> <br />$2,000,000 General Aggregate 1 $1,000,000 Each oçcurrence 1 $1,000,000 Products/Completed <br />$1,000,000 Personal & Advertising Injury!$50,OOO Fire D""",!\e 1 Medical Payments Excluded <br /> <br />$500 BJ & PD Per Claimant Including Loss Adjustment Expense <br /> <br />operations I <br /> <br />$750.00 <br />$23.44 <br />$50.00 <br />$823.44 <br /> <br />Premium (Fully Earned) <br />Taxes (Fully Earned) <br />Certificate Fee (Fully Earned) <br /> <br />Total Amt <br /> <br />1. No Cancellations Allowed. Premium, taxes and fees are fully earned at inception. <br />2. Operations and Rating Based: Consultant - Serve as a hearing officer@ alternative abatement proceeding hearing. <br />3. Department: Planning & Building Department <br />4. Additional Insured(s): Not Applicable <br />5. NO PUBLIC EXPOSURE WORKING WITH THE CITY OF SANTA ANA AND THEIR DEPARTMENTS ONLY. <br /> <br />Asbestos, Assault & BatteI)', EmpJoyer Related Practices, Subsidence, Independent Contractors, Pollution, Cross Suit, <br />Lead or Silica Dust, Mold or Bio-organic Growth or Mildew, Punitive D""",!\es, Animal, Breach of Contract, Y2K <br />Elcctronic Data, Medical Payments, Wsr or Terrorism. <br />The insurance provided under this policy is limited to your work performed on behalf of the entity named as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or your organization. <br />Coverage is limited to the description of operations and rating bases listed in "Tenns & Conditions" item 2. <br />The Tmorism Risk Insurance Act of 2002. requires us to offer you a quote for telTorism coverage. This Quotation is <br />separate and not included in your coverage premium. This coverage must be accepted or rejected by you and the <br />attached fonn returned to us prior to binding. <br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, Inc, 1920 East 17th <br />St Suite 136, Santa Ana, CA 92705 <br /> <br /> <br />1 <br />/2; II'å - <br />- - <br /> <br />Carol Frost I President <br />Municipality Insurance Services, Inc. <br /> <br />APPROVED AS TO FORM <br /> <br />~A~QP~ <br />a ura Sheedy <br />Deputy ÇHy Attorney <br /> <br />1920 East 17th St Suite 136 Santa Ane, CA 92705 (800) 420-0555 (714) 550-5040 fax (714) 550..5044 Licensc# OC04849 <br />