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<br />. ACeRD. <br /> <br />CERTIFIC" OF LIABILITY INSU \NC~~ib1 DA~E~~~~';o)3 <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 AFFORDED BY THE POLICIES BELOW. <br /> <br />PRODUCER <br />North American Ins Agency <br />A Div of Hi1b,Roga1 & Hamilton <br />P.O. Box 6700 <br />Rancho Cucamonga CA 91729 <br />Phone: 909-476-3300 Fax:909-484-5176 <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />Kinkle Rodiger & Spriggs <br />3333 14th Street <br />Riverside CA 92501 <br /> <br />INSURER A: <br />INSURER B: <br />INSURER c: <br />INSURER 0: <br />INSURER E: <br /> <br />Golden Ea Ie Insurance Co <br /> <br />INSURED <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCE 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 />l'rfR: TYPE OF INSURANCE POLICY NUMBER <br />~NERAL LIABILITY <br />A X COMMERCIAL GENERAL LIABILITY CBP9667121 <br />I CLAIMS MADE [!] OCCUR <br /> <br />I ~~f~>;"M/DD'M(\ L <br /> <br />DATE MM/DD1YYl <br /> <br />LIMITS <br /> <br />02/28/03 <br /> <br />02/28/04 <br /> <br />FIRE DAMAGE (Anyone fire) <br />MED EXP (Anyone person) <br /> <br />$1,000,000 <br />$100,000 <br />$ 5,000 <br />$ EXCLUDED <br />$ 2.000,000 <br />$ 2,000,000 <br /> <br />EACH OCCURRENCE <br /> <br /> I-- <br /> - <br /> ~'L AGG~EnE LIMIT APnS PER: <br /> POLICY jr8,: LOC <br /> AUTOMOBILE LIABILITY <br /> I-- <br />A - ANY AUTO CBP9667121 <br /> - ALL OWNED AUTOS <br /> SCHEDULED AUTOS <br /> - <br /> e-! HIRED AUTOS <br /> e-! NON-OWNED AUTOS <br /> I-- <br /> GARAGE LIABILITY <br /> =1 ANY AUTO <br /> EXCESS LIABILITY <br />A :~~rOCCUR D CLAIMS MADE CU9662824 <br /> ~ ~EDUCTIBLE <br /> X RETENTION $10,000 <br /> WORKERS COMPENSATION AND <br /> EMPLOYERS' LIABILITY <br /> <br />PERSONAL & ADV INJURY <br />GENERAL AGGREGATE <br />PRODUCTS - COMP/OP AGG <br /> <br /> COMBINED SINGLE LIMIT $1,000,000 <br /> 02/28/03 02/28/04 (Eaaccidenl) <br /> BODILY INJURY $ <br /> (Per person) <br /> BODILY INJURY $ <br /> (Pefaccident) <br /> PROPERTY DAMAGE $ <br /> (Peraccidenl) <br /> AUTO ONLY. EA ACCIDENT $ <br /> OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EACH OCCURRENCE $ 5,000,000 <br /> 02/28/03 02/28/04 AGGREGATE $ 5,000,000 <br /> 1. '()Rr.,,'! $ <br />t'.:', :i.O \. $ <br /> $ <br /> <br />'~')NL,_.____ <br />',y, , ">> 'V / <br />l)'~\ ':;y ,~ \\ i\\i.1 jjll~Y' <br /> <br />,,_..."~~----- <br /> <br />I f6'R~',')Wisl IUER <br />EL EACH ACCIDENT $ <br />EL DISEASE - EA EMPLOYEE $ <br />EL DISEASE - POLICY LIMIT $ <br /> <br />OTHER <br /> <br />DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />With regards to the Santa Ana Office of the named insured, The City of Santa <br />Ana,its officers,&employees are named as additional insured. *Except 10 Days <br />Notice of Cancellation for Non-Payment of Premium. <br /> <br />CERTIFICATE HOLDER <br /> <br />I y I ADDITIONAL INSURED; INSURER LETTER: <br /> <br />CANCELLATION <br /> <br />SANTAN2 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> <br />City of Santa Ana <br />P.O.Box 1988 <br />Santa Ana CA 92702 <br /> <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 so SHALL <br />IMPOSE NO OBLIGATION OR L1ABIUTY OF ANY KINO UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. ~ /'? <br /> <br />V^v ,L?. & :>. <br /> <br />Linda Burns <br /> <br />ACORD 25-S 7/97 <br /> <br />, <br /> <br />@ACORDCORPORATION1988 <br />