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<br />AC.DBD.N CERTIFICATE OF LIABILITY INSURANCE
<br />PRODUe>.< PREMIER ONE INSURANCE SERVICES
<br />100 PACIFICA 1/480
<br />L1C. NO, OC661S3
<br />IRVINE
<br />(949)127-2025 "
<br />
<br />\
<br />
<br />D...n:{IIIAIlID'YY)
<br />3/14/2005
<br />
<br />THIS CERTifICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFOROED BY THE POUCIES BELOW.
<br />
<br />THE pOLICIES OF INSURANCE LISTED BELOW HAvt BEEN ISSUED TO THE INSURED NAMED ABOVE FO~ THE POUCY PERIOD INDICATED. NOTWITKSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITlON OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS CERTIFlGATE IMY BE ISSUED OR
<br />MAY P.RTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES AGGREGATE l~rTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />':'~ :,' TVl'i Of ""RA'"'' I ," ;;oUCY NiI."i' ' " '.I'i:~~ E""CTIV! ! ~i'l'-J O",,'RA noN I --- U.'" -
<br />[' GiJolIiRAl.I.IADlUTY I ': lEACH OCCURRENCE $
<br />X' COMMfRCIAl OEN'rw. L"'~rrY , ' ;-;., "MlAG' (MY;'" ",) U ,
<br />J C'""'"'^',, [Xl OCCUR MiO EJ<P(MY;"''''-') ,
<br />A _' ' GL30S2698 9127/2004 9/27/2005 ~'?tw.'MlVINJURY:'
<br />GENEtW. AGOfU;;QATE .
<br />~E~'L AGO'"'''' LIMIT AP~' Pi" PRCOUon._ COMPIO~ .!_,
<br />,XiPOLIC'l': i~~i I Iwc
<br />;.~TONOBllllJlBlUTY
<br />_ II).lYAUTO
<br />ALl OWNEO AUTO$
<br />B ~ SCI-4ECULfO AUTOS
<br />H",EO AUTOS
<br />r-- NQN.oWNEO ALllOS
<br />
<br />r-;'
<br />
<br />CA 92616
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />UiSU...
<br />lWATERINC
<br />
<br />INSURER Jl.:.
<br />INSURER B:
<br />INSURf.RO:
<br />~,LNSURER 0: .
<br />INSURER!:
<br />
<br />COLONY INSURANCE CO'--
<br />MERCURY CASUAL TV COMPANY'
<br />State Compensation Insuiiiilce Fund
<br />EVANSTON-INSURANCE COMPANY_ .
<br />
<br />26a3 LAGUNA CANYON RO
<br />LAGUNA B~ACH
<br />COVERAGES
<br />
<br />CA 92651
<br />
<br />,
<br />
<br />COMBINED SINGLE lIMIT
<br />(E'i~d.(l\)
<br />
<br />. 80Pll Y INJURY
<br />(pQl peraon}
<br />
<br />AC11061312
<br />
<br />9/4/2004
<br />
<br />9/4/2005
<br />
<br />BOO~V INJURY
<br />{p.( mooWMnt}
<br />
<br />:'
<br />,,"-'--
<br />
<br />PROPER.TY OAMAGii:
<br />(Plltaccldllllt)
<br />
<br />",--
<br />
<br />-
<br />
<br />1 ,OOOJOOO
<br />50 000
<br />1.000
<br />1,OQ_~
<br />2,000,000
<br />2,000,00l!.
<br />
<br />,
<br />
<br />1,000,000
<br />-
<br />
<br />s
<br />
<br />,/
<br />
<br />AS TO t'ORM
<br />
<br />
<br />-( ~', .,V~C ;' (j"
<br />Laura ,stitt Slieedy, /'
<br />As~w;tant City Attorn y "
<br />
<br />AUTOONl'f -EAACI;IOENT $
<br /> "
<br />: orHER THAt-l E^M.C , .-
<br />. AUTO ONLY: AG<1 ,
<br />EACH OCCURRENC' "
<br /> .",.
<br />~~~.^TE , U'__
<br /> .
<br /> -.
<br />-"' ,
<br /> ,
<br />
<br />nRAl;ai~lllY
<br />
<br />~'I MY I\U1"O
<br />
<br />EXCElS llA8lUTY
<br />~j'OCCUR U ClAIMS MADE
<br />
<br />'I
<br />: OEDUCn6L~
<br />i RETENTION $
<br />, WORKERS COMPENSATION AND
<br />i EMPLCN'fRS'L.IADlUTY
<br />
<br />APPROVEI
<br />
<br />-y;;,
<br />
<br />167532604
<br />
<br />1/1/2005
<br />
<br />1/1/2006
<br />
<br />~ I TOR"(['IMI,ol :o~~
<br />E.L EACH ACCIDENT . i
<br />~.~I.G~..EAEW'LOYEF.: ~
<br />E.L DISEASe. P01..lCYL1UlT 1 S
<br />PER OCCURRENCE
<br />AGGREGATE
<br />OED
<br />
<br />C
<br />
<br />aTllE'
<br />o E & 0 INSURANCE E0820511 i 6/12/2004
<br />
<br />oESCRlPl1OH OF OPfRATlOHSlL.OCATtONS/VEKIClE3IfJl;CL.U5toNS ADDl:D BY l1;NOOR:il.EMEHT/SPECIAL. pI\O\'WIOHII
<br />RETRO DATE ON E & 0 INSURANCE 6112103.
<br />
<br />6/1212005
<br />
<br />'"""
<br />~~o.O.OOO
<br />~OOO.OOO
<br />1,000 000
<br />1,000,000
<br />1,000,000
<br />5,000
<br />
<br />CANCELLATION
<br />
<br />aHOULDN;("( Of THE ABOvE DESCRIBED POUClEi 8ECANCEl.LlO .IEJ'~ THe: V::P1RATION
<br />
<br />DATE TH~toF. 'THE 1I1U1NG INiURER WILL. ENDeAVOR TO MAlL. ___ CAY$ WfUTTEN
<br />
<br />NOT1C~ TO THE camFtCAIf. HOI.De-A. N,6,UED TOTHE lEFT, JUT F.u..URfTO DO so IHALI.
<br />
<br />IMPOR: NO OBUGA'11ON OR I.IABlUTY OF ~'( KIND UI"ON THE 1N9URER,1T1 AG!NT$ OR
<br />
<br />Rl!PAUEMTAllVES....--.. _/l
<br />
<br />..""'RaE' ......-~TIVE- / "/. I
<br />/ _,~ d/./,I-')..... ~
<br />
<br /><--:::",- L/ "A<;QIID CORPORATION 1588
<br />If': '..f''tV ~1,1l_81111;!.'1"'05 .1.;poI7/U~am" PFy1.0.1
<br />
<br />CERTIFICAte HOLDER I - -I ADDmONAt.INISUREO;1N~RERU:TTER:
<br />
<br />ACORO 25-5 (7/ll7l
<br />lM: LPW v1.9,6 on 311.~' 12:011 by uwHilI1'O
<br />
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