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<br /> .... I
<br />ACQRfJN CERTIFICATE OF LIABILITY INSURANCE CSR MS DAoTE (IlMJDDlYYYYl
<br />PROBO-l 05/19/05
<br />PROuUCER THIS CERTIFICATE IS ISSUED AS A MAlTER OF INFORMATION
<br />Freeman & Pearce Ins. - COCIA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />Lie, #0559854 HOI.OER. nlls ceRTIFICATE DOES NOT AMEND, EXTEND OR
<br />1216 N. Tustin st.z:eet AI. TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Orange C," 92867
<br />Phone: 714-55B-1334 Fax:714-62B-1330 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED ,. . ". ,<,.... I_~ 1..-'.
<br /> INSURER A; ~erican ~asualty ,go of
<br /> -...... ".-
<br /> INSURER B: Readinq.! PA
<br /> PltOBOLSKY USEARCfI ....'. -
<br /> ~ D. PrQbobk~ INSURER C:
<br /> #206 ...
<br /> 23 16 S. POINTE R~VE, INSURER. 0:
<br /> LAGUNA HILLS CA 92 53 ---'-"--.. ,", ..-
<br /> lNi;lURER E:
<br />
<br />MAY 19 2005 14:30 FR FREEMAN - PEARCE
<br />
<br />714 628 1330 TO 19498556405
<br />
<br />P.02/04
<br />
<br />THE PO~ICIES OF INSURANCE LISTED IilELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE pouCY PERIOD If'lDICATED. NOTWITHSTANDING
<br />ANY REQUI~E"'EHT, TERM OR CONDITION OF ANV CONTRACT DR OTHeR DOCUMENT ~TH R~&PECT TO 'M'lICHTH1S CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INsuRANCE AFFORD EO BY THIi. POLICIES OESCRIBeo HER.ElN IS SUIiJEcr TO ALl. THE TERMS, EXC~USIONS AND CONDITIONS O~ SUCH
<br />POLICIES. AGGReGATE LIMITS SHOWN MAY l'tAVE BeeN RECUCf;D BY PAID CLAIM::;.
<br /> -- '. ~~MJDDNYl .._,' n. ...... ,,-
<br />L.TR NSRC Tl'I'E OF INSURANCE PO~IC\' NUMBER rD"A"re 111M1DDtvYi UMITS
<br /> GEN~L L.IABILITY ~CH OCCURRENCE S L 000,000
<br /> !-- 06/06/04 06/06/05 O"R".. , ".. .~
<br />A X ~ cOMMERCIAl. GENERA~ ~lABILlTY B 1073363845 ~.sMIS=$ (Ei oCl;Urvn~9)_ 5100,000
<br /> I-- ':J CUlIMS MADE ~ OCCUR _MED EXP (Atly one pe,,!onl 5 5,000
<br /> PERSONAL &ADV INJURY $ 1,000,000
<br /> :-- GEN~RALAGGREGATE S 2,000 r 000
<br /> GEN'~ AGCREOATE l.IMrT APP~IES PER: ~~TS - COr.APIOP AGG 52,000,000
<br /> I POLlCy-n ~r8i - n LOC
<br /> , AUTOMOBILE. LIABILITY COMBINED SINGLE LIMIT sl,OOO,OOO
<br /> ,""'-
<br />A , '_ ANY AUTO B 1013378815 06/06/04 06/06/05 (Ea eccldenl)
<br /> -"." ---
<br /> - A~~ OWN EO AUTOS BODILY INJURY
<br /> S
<br /> SCHEOU~EiO AUTOS (por .,.,raon)
<br /> - . ...-
<br /> ~- HIRliD AuTOS BOOIL Y INJURY
<br /> (pot aceldent) $
<br /> ,It NOf'l-(lwNED AUTOS
<br /> "
<br /> PROPERTY DAMAGE S
<br /> (Per~idCll'1t)
<br /> RAAGE LJABIUTY AUTO ONLY. EA ACCIDENT S
<br /> ~Y AUTO OTHER THAN fA ACe $
<br /> AUTO ON~Y: AGG S
<br /> ~CESSlUMBRELL.A ~LA.B1UTY EACH OCCURRl:NCE S
<br /> o OCCUR D CLAIMS MADE ,\PPROVEU \S 1'0 FO Uvi AGGREGATE S
<br /> ,,-
<br /> R s
<br /> ,I/u /15 .-.
<br /> DEDUCTIB~E ~<);' S
<br /> >- "--1/, .-...-
<br /> f\ETENTION $ S
<br /> WORKERS COMPeNSATION AND Laura S itt Sheeoy ITo~Y';(I~I'ys I II,I~~-
<br /> EMP~OVERS' LlA8IUTY Assistant ( .ity Att(~rn,-,\' ~-
<br /> ANY PROPRIETORlPARTNERlEXECUTIVE e:.L EACH ACCIOENT 5
<br /> OFF1CERlMEMBER EXC~UCeD? E,~, OISI:A$E. EA EMPLOYEE $
<br /> ~~~~I~'P't~V~~~S below ELL DISEASE - PO~ICY LIMit S
<br /> OTI\ER
<br /> !
<br /> I
<br />DESCRIPTION OF OPERAl1ONS I L.O<:A liONS J VEHIC~E$ J exCLUSIONS ADDED BY ENDORSEIlIENT I SPECIAL PROVIllIONS
<br />'rHE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENl1'S, VOLt,lmEERS AND
<br />!U:PRESENTAT'IVES ARE NAMED AS ADD'I'I'l'ONAL INSURED PER COMPANY FO~ #G-134802B.
<br />THIS INSURANCE IS PR.IMARY AND NON-CONTRlaUTORY.
<br />
<br />COVERAGES
<br />
<br />CITY OF S~A ANA
<br />20 CIVIC CENTER PLAZA
<br />S'-NTA ANA CA 92701
<br />
<br />CANCEL.LA TION
<br />SANTO 0 1 SHOU~D ANY OF THE ABOVE DesCRIBED POl.ICIES BE CAt.lCELLED BEf'OR~ THIi ElI;PIRA liON
<br />DATE lHEREOF, THI; I$SUING INSURER WILL ENDEAVOR 1'O MAIl. ~ DAYS wRlnEN
<br />NOTICE TO THI: CEIlTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so $HALL
<br />IMPOSE NO 08UGAl10N OR Llllan.ITY OF ANY KIND UPON TH!: INSURER, mi AGENTS Oft
<br />REPRE5ENTAnVEI.
<br />AUTHORIZED Rl!AAIi$lO
<br />
<br />
<br />@ACORDCORPORATION1988
<br />
<br />CERTlFICA TE HOLDER
<br />
<br />ACORD 25 (2001/08)
<br />
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