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<br />A COROm
<br />
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<br />::I::\::~::::(:\:::::t:::::::::::t::t:::)::?:::::{t::: DATE IMM/DDfYYJ
<br />Ito 1 / 2 6 / 2 0 0 5
<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 AFFORDED BY THE POLICIES BELOW.
<br />COMPANIES AFFORDING COVERAGE
<br />COMPANY Fireman's Fund Insurance Companie
<br />A
<br />
<br />PRODUCER Nicholas Goldware
<br />Talbot Ins & Fin Srvcs, Inc.
<br />4371 Latham Street Suite 101
<br />PO Box 5345
<br />Riverside, CA 92501
<br />951-788-8500 ... fax951-788-2994
<br />INSURED
<br />Kinkle, Rodiger & Spriggs
<br />3333 Fourteenth Street
<br />
<br />COMPANY
<br />B
<br />
<br />Everest National
<br />
<br />Insurance Compan
<br />
<br />
<br />COMPANY
<br />C
<br />
<br />Riverside CA 92501
<br />
<br />
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />CO
<br />LTR
<br />
<br />TYPE OF INSURANCE
<br />
<br />POLICY NUMBER
<br />
<br />POUCY EFFECTIVE POUCY EXPIRATION
<br />DATE IMMJDDfYYI DATE IMMJDDIYYI
<br />
<br />UMITS
<br />
<br />A GENERAL LIABIUTY AZC80724565
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE 00 OCCUR
<br />OWNER'S & CONTRACTOR'S PROT
<br />
<br />04/01/2004 04/01/2005
<br />
<br />GENERAL AGGREGATE 2 , 000 I 000
<br />PRODUCTS - COMP/OP AGG $ 2, 00 0 , 000
<br />PERSONAL & ADV INJURY $ excluded
<br />EACH OCCURRENCE $ 1,000,000
<br />FIRE DAMAGE (Anyone fire) 100 , 000
<br />MED EXP {Anyone person) 5, 000
<br />
<br />A AUTOMOBlLELlABIUTY AZC80724565
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />X HIRED AUTOS
<br />X NON-OWNED AUTOS
<br />
<br />04/01/2004 04/01/2005
<br />
<br />COMBINED SINGLE LIMIT $ I, 000 I 000
<br />
<br />BODILY INJURY
<br />lPerperson)
<br />
<br />,)
<br />
<br />
<br />BODILY INJURY
<br />(Per accident)
<br />
<br />PROPERTY DAMAGE
<br />
<br />GARAGE LIABILITY
<br />ANY AUTO
<br />
<br />AUTO ONLY - EA ACCIDENT
<br />
<br />A EXCESS LIABILITY
<br />UMBRELLA FORM
<br />OTHER THAN UMBRELLA FORM
<br />B WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />
<br />UMB04012003
<br />
<br />OTHER THAN AUTO ONLY:
<br />EACH ACCIDENT
<br />AGGREGATE
<br />04/01/2004 04/01/2005 'ACHOCCURR'NC'
<br />
<br />ney
<br />
<br />AGGREGATE
<br />
<br />$5,000,000
<br />$5,000,000
<br />
<br />CA200101900S1
<br />
<br />01/13/2005 01/01/2006
<br />
<br />
<br />THE PROPRIETOR/
<br />PARTNERS/EXECUTIVE
<br />OFFICERS ARE:
<br />OTHER
<br />
<br />INCL
<br />EXCL
<br />
<br />EL DISEASE - POLICY LIMIT
<br />EL DISEASE - EA EMPLOYEE
<br />
<br />1,000,000
<br />1,000,000
<br />$1,000,000
<br />
<br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIALITEMS
<br />Re: Verification of Coverage for Workers Compensation
<br />
<br />
<br />City of Santa Ana
<br />Attn: City Attorney Joseph W. Fletcher
<br />PO Box 1988
<br />Santa Ana, CA 92702-1988
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF. THE ISSUING COMPANY WilL ENDEAVOR TO MAil
<br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
<br />ITIICfays notice for non-payment
<br />BUT FAILURE TO MAil SUCH NOTICE SHAll IMPOSE NO OBLIGATION OR L1ABIUTY
<br />OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />
<br />@ds:lf;1673467
<br />
<br />81311
<br />
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