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6l endel• Insunnee Apenay <br />760 Felrnont Avenue <br />P. 0. Bex 891 <br />S ArMele cA 51205-0837 <br />PhasnlX 8rsup Infermetl en Sys. '`~a~- ~~Q <br />380 Van Mae Bey, p73D <br />Tsrrsnse, CA 50607 <br />A10LDER. THIS <br />COMPANY <br />A <br />COMPANY <br />B <br />COMPANY <br />DOES NOT AMEND, EXTEND OR <br />COMPANY <br />ceAT7FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED RY THE POLICIES DESCREBEI <br />EXCLUSIONS AND CONDITIONS OF SVCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAI <br />L7N 7700 OF NAMANtl POLICY MUNpe IOLICT SPPACTIYA POLICY All-MATIO <br />TERMS, <br /> A <br />DAip (MAOpDIYY) <br />OA7[(MMA)DlYY) ti <br />LIM <br />Re <br />A OSN58AL UALLm <br /> <br /> <br />)( COMMERCIAL GENERAL LIABILITY 725BAA82636 <br />10/01/04 <br />10/01/06 <br />GENERAL AoOgEOATE <br />J 2, <br /> <br /> <br />• • <br />CLAIMS MADE ~ OCCIq PROIXICTS-COAP/OP A00 f 2~ <br /> OWNER'S c CONTRACTOR'S pg0i PERSONAL c ADV INJURY J 1, <br /> EACH OCCURRENCE S 1 <br /> FIRE DAMAGE (Arty aro Nre) f <br /> AU TOMOALS LIYLIrY <br />728BAA MED EXP (My one pwadl) S <br /> <br />ANY AUTO 82536 10/01/04 10/01/06 <br /> COA101NED SINGLE LIMIT J <br /> ALL OWNED AUTOS 2, <br /> SCHEDULED AUTOS BODILY INJURY J <br /> (Par person) <br /> )< HIRED AUTO) <br /> ] NON-0WNED AUTOS SObILY INJURY T <br /> (Pw eccldenl) <br /> PROPERTY DAMAGE f <br /> OA NAOS LIA.Lm <br /> ANY AUTO AUTO 01LY • EA ACCIDENT J <br /> OTHER THAN AUTO ONLY T <br />. <br />~~~~~~ <br /> EACH ACCIDEN7 ~ <br /> d~ ee LJAALIrT Ldi1I6 $ <br />~ iC1 $11DCd AOOgEGATE f <br /> <br />UMBRELLA FORM l <br />SSTSCd¢C ity Attorney EACH OCCURRENCE f <br /> OTTER THAN lAt)gELLA FORM AO(iREGATE p <br />5 WONKgpCOMMNMTION ANO f <br /> SMPLOYpAp. uASLRY 72SECK095B3 10/01/04 10/01/06 W A ~ <br /> TIE PROPRIETOR/ IN0. <br />PARTNERS/EXECUTIVE EL EACH ACCIDENT t ~T~ O <br /> <br />OFFICERS ARE; <br />EXCL EL OISEASE~POLICY LIMIT i <br />1,0 <br /> OTNSN EL DISEASE-EA T],ELOYEE ! 1 0 <br /> eesnlerelAl Cr 18e Polley 6407223 <br /> 11/16/03 <br />11/16/04 <br />SS76,D00 LIDIt per <br />Oeaurnnee <br /> f26,000 Oedustlbl• <br />7etO N PTO O O OGTM N CIAL <br /> <br />Ins <br />ured N/re5erd to General Ll ebl I <br />Illy eewre8o end <br />e <br />th t Is .prod thet the clty of Sen ts Am Is neneq Atldl tl enel <br /> p <br />r <br />e etLOhe d Addlt tonal Ine und Endensment . <br />Clty of 4snL Ana <br />Attentlen: Leure Shoddy <br />20 Clrlo Csntsr Plsae <br />8ente Ane, CA 52701 <br />spoon AMr OP TNS MOVp DAeO11MAD -OLN:1[e ^f OAMCrLLW aafOBS THS <br />aXPMATION DATA 771SI1pOP, 7145 MpUOdO DD1A-ANY WLL SNDSAVOa TD MAL <br />36 DA17 WArT1pN MOi1W TD YNN OaN7lIOATa NOLDSA NAMMI TO7Na LIFT, <br />aUT PALYaa lb MAL aupN NOTIOp aMALL IMroY MO OaLNiATl011 011 LIAaLRY <br />OP ANY KWD UlOM TNS OOMgAyy_ M AO~,Q~nV11ppANTAT1YSi <br />C IOa N I 11 -~ <br />`$c; ~~ ~ `Peu ~bi~ <br />