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<br />I. At;PRD. CERTIFICATE OF LIABILITY INSURANCE OP IOl~ DATE (MMJDDNYYY) <br />URBAN-l 05/05/04 <br />'''RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />ISU Ins Srv - Fullerton Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1150 E Orangethorpe Ave,#lOl ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Placentia CA 92870 <br />Phone:714-577-5800 Fax:714-577-5888 INSURERS AFFORDING COVERAGE NAIC# <br />--,. .. Western Heritaae <br />INSURED A -.;lOO3 -.;;I.DS INSURER A:. Insurance <br /> INSURER B: <br /> Urban Graffiti Enterprise INSURER C <br /> Juan Reino~3 <br /> P. O. Box 83 f/ )¡ l.tJ ~ INSURER D. , <br /> Covina CA 91722 I <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW1THSTANDING <br />ANY REQUIREMENT, TrRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE IN'. JRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> <br />A <br /> <br />TYPE OF INSU RANCE <br />GENERAL LIABILITY <br />X ~MMERCIAL GENERAL~JABILITY <br />¿ CLAIMS MADE ~ OCCUR <br />~'.j Owner / Con t:~~_t.'..,~ <br />I .. <br />, GEN"L. AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />JECT <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br /> <br />POLICY NUMBER <br /> <br />. L <br />DATE MMIDDfYY <br /> <br /> <br />EACH OCCURRENCE <br /> <br />LTR NSR <br /> <br />---- <br /> <br />LIMITS <br />:.1000000 <br />.50000 <br />.1000 <br />.1000000 <br />.2000000 <br />.2000000 <br /> <br />SCP0504460 <br /> <br />02/18/04 <br /> <br />02/18/05 <br /> <br />PREMISES Ea oco.Jrencø) <br />MED EXP (Anyone per$On) <br />PERSONAL &ADV INJL'RY <br /> <br />GENERAl AGGREGATE <br />PRODUCTS - COMPfDP AGG <br /> <br /> <br />Loe <br /> <br />ALL OWNED AUTOS <br />SCHEDULED AlJTOS <br /> <br />COMBINED SINGLE LIMIT $ <br />(Eaaccidønt) <br />BODILY INJURY . <br />(Perpersan) <br />BODII. Y INJURY $ <br />(Per accident) <br />PROPERTY DAMAGE . <br />(Pêraccident) <br /> <br />HIRED AUTOS <br /> <br />NQN.OWNED AUTOS <br /> <br />GARAGE WI, 11l1TV <br />ANY AUTO <br /> <br />QTHE;R THAN <br />AUTO ONLY: <br /> <br />AUTO DNL y. EA ACCIDENT $ <br />EAACC $ <br />AGG i S <br /> <br />EXCESs/UMBRELLA LIABILITY <br />~J OCCUR 0 CLAIMS MADE <br />1 <br />r--- <br />! I DEDUCTIBLE <br /> <br />EACH OCCURRENCE <br />AGGREGATE <br /> <br />. <br />$ <br />$ <br />$ <br />$ <br /> <br />.- <br /> <br />/\ <br />( ./ <br />-'~-,'') <br />. "{.UA <br /> <br />{ <br /> <br />",'/et> d. <br />// <br /> <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PR,OPRIETORJPARTNE;RIEXECUTIVE <br />OFFiCERfMEMBER EXCLUDED? <br />~~Ë~11~s~~'õv~~Ö~S below <br />OTHER <br /> <br />,. <br /> <br /> <br />$ <br />E.L, DISEASE - EA EMPLOYEE $ <br />E,L DISEASE. POLICY LIMIT ~ <br /> <br />~ <br /> <br />'-..-- <br /> <br />DESCRIPTION OF OPERATIONS { LOCATIONS I VEHICLES' EXCLUSIONS ADDED BY ENDOR:!IEMENT J SPECIAl PROVISIONS <br />The certificate holder is n~ as additonal insured with regards to qeneral <br />liabiliy for work performed by insured per the attached blanket endorsement <br />CG 2033, R~)ve Graffiti.* 10 days notice of cancellation for non <br />payment of premium. <br /> <br />CERTIFICATE HOLDER <br /> <br />SANTAA2 <br /> <br />CANCELLATION <br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL H MAIL * 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 81H r II !!l.ll 1.1::. <br /> <br />City of Santa Ana <br />Public Works <br />Projects Mgr <br />220 So Daisy <br />Santa Ana CA 92703 <br /> <br />Ir1r <br /> <br />1_...._,. -"~-'-" ¡~. ..... ""''''VI -.. <br /> <br />JIJRI!8 In 81! <br /> <br />R Tl'iS. <br />AUTHORIZED RfPRESENTA TlV <br /> <br /> <br />~CORD 25 (2001/08) <br /> <br />David Hood <br /> <br />IVf1p,,/ <br />