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1125 DATE (MM ACDRD. CERTIFICATE OF LIABILITY INSURANCE 0'120DONYYII l/252004 Collinsworth, Alter, Fowler, Dowling & French Group Inc. P. 0. Box 9315 Miami Lakes, FL 33014-9315 INSURED W. Koo & Associates, a division of PBS&3 2001 NW 107 Avenue Miami, FL 33172-2507 rromcencc ONLY AND CONFERS NO RIGHTS UPON HOLDER. THIS CERTIFICATE DOES NOT INSURERS AFFORDING COVERAGE 111,JFERA Sentry Insurance a Mutual Com_ In] FEFE CtP.dfact Tno,ranra ('mm.a.v A H JPFF F, N_JREF E NAIC # Iy A+ XV THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION T R TYPE OF INSURANCE POLICY NUMBER DATE MMIDD LIMITS GENERAL LIABILITY 90-15807-03 09/30/2004 09/30/2005 EACH POP JRRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TOREC`ED $ 1,000,00 CL AIMS MADE X OCCUR MEDEXP(AlryoRFerson) $ 25,000 PERSONAL&ADVINJURY $ 1,000,000 A X Contractual Liab GENERAL AGGREGATE $ 2,000,00 GEN'L AGSREGATE LIMIT APPLIES PER PRODUCTS-COMCOPAGG $ 2, DD0,00 _—. PRt1 POLCY X dECT X I LCC AUTOMOBILE LIABILITY 90-15807-04 09/30/2004 09/30/2005 COMBINED SINGLE LIMIT X ANYAUTO 90-15807-05 (Ea act dent) $ 1,000,00 X ALL ONMED AUTOS EODILY wdLRY $ SCHEDULED AUTOS APPROVED YYll AS TO FORM .Parpers.n, A X HIRED AUTOS EGDILYINA $ X NDILLDWNED AUTOS (PeraP:itlenl) dA'L X Contractual Liab �J/ LBu PkGPEAGE (PeraaitleniJent) p $ SlS eed GARAGE LIABILITY - SS18La it CAY Attori LeyAUTO ONLY EA ACCIDENT $ ANYAUDL OTHEEAACC THAN $ $ AUTO ON AUTO ONLY AGO EXCESSIUMBRELLALIABILIIY AUCS08762100 09/30/2064 09/30/2005 EACH OCCURRENCE $ 25,000,00 X OCCUR CLAIMS MADE AGGREGATE $ 25,600,00 B $ DEDUCTIBLE $ X RETENTION S 10,00 $ WORKERS COMPENSATION AND 90-15807-01 09/30/2004 09/30/2005 X WR STAUL' DER A EMPLOYERIETOR LIABILITY ANY PROPRIET9R'PARTNERIE%<ECLTIVE 90-15807-02 EL EACH ACCIDENT $ 1,000,06 ELDISEASE-EAEMPLOYEE $ 1,000,00 OPFCERMEMBER EX.CLUDED9 Tq tlesanbeuMer 5�ECIAL PROVISIONS Lelore NO EL DISEASE-POLICYLIMIT $ 1,000,00 OTHE Prrooessional/ P42304 09/30/2004 09/30/2005 $1,000,000 Limits C Pollution Liability Ea Claim and Annual Aggregate CLAIMS -MADE FORM 11/11/1961 Retrodate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS e: ASOS50.05 Santa Ana Bridge. Santa Ana, City of Public Works Agency and City of Orange are named additional insured on the General liability, excluding professional services. Insurance evidenced by this certificate shall be primary and non-contributory to that of the named additional insured; said coverage contains severability of interest provision. Issuing companies will provide 30 days written notice of cancellation. Santa Ana, City of Public Works Agency Attn: Taig Higgins 20 Civic Center Plaza Santa Ana, CA 92707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 7FX)MX%XAA1L 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, KMNDtAU(7t71fJ )ikC xDEN%dk1574xxx*YA)OKII(MX'Df[ M)GX94MXXXXX AUTHORIZED REPS Meade Coll ACORD 25 (2001/0S) ©ACORD CORPORATION 1988