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<br />. MA-RSH <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />CERTIFICATE NUMBER <br /> <br />LOS-000448771-01 <br /> <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br />NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE <br />POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />AFFORDED BY THE POLICIES DESCRIBED HEREIN. <br /> <br />PRODUCER <br />Marsh Risk & Insurance Services <br />4695 MaCJ\rthur Court, Suite 700 <br />(949) 399-5800 <br />License #0437153 <br />Newport Beach, CA 92660 <br /> <br />GoodwiUlndustries of <br />Orange County, Inc. <br />410 N. Fairview <br />Santa Ana. CA 92703 <br /> <br />I-- <br /> <br />I CO";:'ANY Philadephia Indemnity Company <br /> <br />COMPANY <br />B <br /> <br />COMPANIES AFFORDING COVERAGE <br /> <br />INSURED <br /> <br />COMPANY <br />C <br /> <br />COMPANY <br />0 <br /> <br />COVERAGES <br /> <br />THIS IS TO CERTIFY THAT POLICIES OF !NSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED <br />NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br />co 1 <br />LTR <br /> <br />POLICY NUMBER <br /> <br />--,----- <br />POLICY EFFECTIVE <br />DATE (MMIDDIYY) <br /> <br />------,------'~ <br /> <br />.~---. ~--- <br /> <br />TYPE OF INSURANCE <br /> <br />POLICY EXPIRATION <br />DATE (MMIDDfYY) <br /> <br />LIMITS <br /> <br />A <br /> <br />x <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />CLAIMS MADE [8] OCCUR <br />OWNER'S & CONTRACTOR'S PROT <br /> <br />PHPK085995 <br /> <br />07/01/04 <br /> <br />07/01/05 <br /> <br />GENERAL AGGREGATE <br />PRODUCTS-COM~OPAGG <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />3.000,000 <br />3.000.000 <br />1,000,000 <br />1,000.000 <br />100,000 <br />10.000 <br />1,000,000 <br /> <br />GENERAL LIABILITY <br /> <br />PERSONAL & ADV INJURY <br />EACH OCCURRENCE <br /> <br />, , <br />~..----I <br /> <br />----I <br />, <br /> <br />FIRE DAMAGE (Any OIle fire) <br />MED EXP An one erson <br /> <br />AUTOMOBILE LIABILITY <br />r--:-;I <br />A X, ANY AUTO <br />ALL OWNED AUTOS <br /> <br />: PHPK085995 <br /> <br />107/01/04 <br /> <br />I <br /> <br />107/01/05 <br /> <br />I COMBINED SINGLE LIMIT <br />I <br />f--- <br />I BODILY INJURY <br />(Per person) <br />----- <br />BODILY INJURY <br />(Peracddent) <br /> <br />i$ <br /> <br />$ <br /> <br />SCHEDULED AUTOS <br />HIRED AUTOS <br /> <br />-------- -..--- --..- <br /> <br />$ <br /> <br />x <br /> <br />NON-DWNED AUTOS <br />1.000 COMP 1 COLLISION <br /> <br />PROPERTY DAMAGE <br /> <br />$ <br /> <br />GARAGE LIABILITY <br /> <br />AUTO ONLY - EA ACCIDENT <br />OTHER THAN AUTO ONLY <br /> <br />$ <br /> <br />~ ANY AUTO <br />H <br /> <br />UMBRELLA FORM <br />I OTHER THAN UMBRELLA FORM <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br /> <br /> <br /> <br />EACH ACCIDENT $ <br />AGGREGATE I $ <br /> <br />I :::~~~:ERREN~_n- .J - - .. =----= <br /> <br />:$ <br />A - <br />TORY LIMITS <br />EL EACH ACCIDENT <br /> <br />ER <br />,$ <br />EL DISEASE-POLICY LIMIT $ <br />EL DISEASE-EACH EMPLOYEE $ <br /> <br />EXCESS LIABILITY <br /> <br />THE PROPRIETOR! <br />PARTNERs/EXECUTIVE <br />OFFICERS ARE: <br />THER <br /> <br />-¡ <br /> <br />LIura SUt Sto <br />ASS*ailt City Att <br /> <br />rney <br /> <br />DESCRIPTION OF OPERATlONSILOCATIONSNEHICLESISPECIAL ITEMS <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are additional insureds under general liability and auto liability as required <br />by written contract. <br /> <br />Endorsement by carrier to follow. <br />CERTIFICATE HOLDER <br /> <br />CANCELlATION <br /> <br />SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, <br />THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL --3.0 DAYS WRITTEN NOTICE TO THE <br /> <br />City of Santa Ana <br />Attn: Terry Gilbreth <br />20 Civic Center Drive, M-37 <br />Santa Ana, CA 92702 <br /> <br />CERTIFICATE HOLDER NAMED HEREIN. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR <br /> <br />LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE <br /> <br />ISSUER OF THIS CERTIFICATE <br /> <br />MARSH USA INC. <br />BY: Stephen Flynn <br />MM1(3/02) <br /> <br />fØ-+ <br /> <br />VALID AS OF: 12/07/04 <br />