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<br />PRODUCER Nicholas Goldware THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />Talbot Ins & Fin Srvcs, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />4371 Latham Street Suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />PO Box 5345 COMPANIES AFFORDING COVERAGE
<br />Riverside, CA 92501 COMPANY Fireman's Fund Insurance Companie
<br />951-788-8500 ... fax951-788-2994 A
<br />
<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 />COMPANY
<br />o
<br />
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L1STEO BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEO ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, 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 />CD
<br />LTR
<br />
<br />TYPE OF INSURANCE
<br />
<br />POLICY NUMBER
<br />
<br />POLlCY EFFECTIVE POLICY EXPIRATION
<br />DATE (MM/DDNYI DATE (MM/DD/YY)
<br />
<br />LIMITS
<br />
<br />A GENERALUABILlTY AZC80724565
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE [K] OCCUR
<br />OWNER'S & CONTRACTOR'S PROT
<br />
<br />04/01/2004 04/01/2005
<br />
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMP/OP AGG
<br />PERSONAL & ADV INJURY
<br />EACH OCCURRENCE
<br />FIRE DAMAGE (Anyone fire)
<br />
<br />$ 2,000,000
<br />.2,000,000
<br />$ excluded
<br />$1,000,000
<br />.100,000
<br />5,000
<br />
<br />MED EXP (Anyone person}
<br />
<br />A AUTOMOBILE LIABILITY 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
<br />
<br />1,000,000
<br />
<br />BODilY INJURY
<br />(Per person)
<br />
<br />.j 'Ld AS
<br />
<br />
<br />BODILY INJURY
<br />{Per accident)
<br />
<br />PROPERTY DAMAGE
<br />
<br />GARAGE LIABILITY
<br />ANY AUTO
<br />
<br />A EXCESS LIABILITY
<br />UMBRELLA FORM
<br />
<br />UMB04012003
<br />
<br />AUTO ONLY - EA ACCIDENT
<br />OTHER THAN AUTO DNL Y:
<br />EACH ACCIDENT $
<br />AGGREGATE $
<br />04/01/2004 04/01/2005 EACH OCCURRENCE .5,000,000
<br />AGGREGATE $ 5,000,000
<br />
<br />ney
<br />
<br />OTHER THAN UMBRELLA FORM
<br />B WORKERS COMPENSATION AND CA2 0 0 1 0 19 0 0 51
<br />EMPLOYERS' LIABILITY
<br />
<br />01/13/2005 01/01/2006
<br />
<br />
<br />$1,000,000
<br />EL DISEASE - POLICY LIMIT $ 1,000,000
<br />EL DISEASE- EA EMPLOYEE $ 1,000,000
<br />
<br />I THE PROPRIETOR/ INCl
<br />PARTNERS/EXECUTIVE
<br />OFFICERS ARE: EXCl
<br />OTHER
<br />
<br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESfSPECIAL ITEMS
<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 MAlL
<br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />TTIlCrays notice for non-payment
<br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUQATION OR LIABILITY
<br />OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />
<br />@ds#1673467
<br />
<br />81311
<br />
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