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~ DATi; FlpPsVED BY l?J>l,V: :':. ' nMY ~~ A PlJbn~ SeNice Agency CERTIFICATE OF INSURANCE Motor Carriers of Property . ,":~i ;~FiciBRII!R.'(eA)'f ~{(if CAj:1024 lI-lSU~ER ilNSURANCE COMPANY) NAIC # 5 Sta.tus: [NAME, ADDRESS, J..ND P~ONE HJ 16 35 ZORICH AMERICAN I:NS. COMPANY OTH!:R # lXJ Ucensecl to write insuranoe In the State of California 801 N'_ BRAND BLVD.. , il?H (Admitted InSl.Jrer) GLENDp,E, CA 91203 0 NonadmittEld Insurer subject to Section 1763 'of the. California Insurance Code. D Charitable Risk Pool BlJl'lpl.US IJNE BROKER NAME NAME OF INSUACR'S AlJ1HORIZEO.AEPflESENTATll/.e ALEXLIO' INSURED (MOTOR CARFlII:R t>!AME AND ADDRESS) Flied with the: I UNITIID STORM WATER, INC. California D.epartment.of Motor Vehicle~ Motor Carrier Permit Branch .ATTN': JAMF-S ~ P. O. Box 932370 MS Ga7S 14000 E. VAf..LEY BLVD. Saciame.nto, CA 94232-3700 i err!' OF INDIJSTRY I CA 91746 (916) 657-8153 Insurer certifies that the motor carrier of property Identified herem (Insured) IS covered by an Insurance policy proVldin!1 bodily, Injul)' or death /IabHity, propertY damag~ liability Insurance, o~ Workers' Compensation Insuranoe within the coverage limits fden~ tffied below and as required by Califomia Vehicle Code sections 34630,34631.5,34640, and by' Part 387 of Title 49 of the Code of Federal Regulations. TYpe OF' INSURANce Polley NUMBeR pouer EFFEC'l1vi; LIMITS j DA T~ (MMrDPfYY) PRIMARY LIASIUTY COMBINIED ~I~~LE LIMIT. $ 1,000,000 o CovP,lI'~ge below SlalutorY minimum BODILY INJURY OR DEA. TIi $ rllTlim. . (ONE PERSON) aAP 525843.3-02 ,1.1/16/05 BODII. Y INJURY 0 a DEATH $ , e3 GOV&l'9t1l1 B~aJ t.o or nC99C1lng (MORE TIiAN ONE PERSON) ~rY minimum IImila. PFlOPEFlTY DAMAGE $ . , '___"_"'_".__a. _......__._.._ ---.-----...--- 1-0-.....____ '" . COMB/NED'SINGLE 4M 1M EXCESS UAsrLITY UMTT $ In exc= of $ BODILY INJURY ' . I o Cov~e blttwG~rim:slry cover" (ONE PERSON) $_lnexCQSecl $ age IJ ~ry nlmlJm limila. BODILY INJURY OR I ~ Coy~r~,;e provfdl;!r;I el or above SID 5258438-02 11/16/05 DeATK (MOflETHAN $_lraxCQSs of s: ,I Sl$IlOry mln!mulll IIrnllll. " , ONE PE;RSON) PRC:>PERTY DAMAG~ $ _in.exCQts ot$ ~ORKFRS.COMPENSATtQN o we Sta1Utory Urnlts , Insurer certifies triat this insurance policy covers ~[f vehicles used in conduc:tlng the service performed by the Jnsur~d for whfch l motor qarrier permit is required whether or. not said vehicle is listed in the insurance policy. . InstJrf1r cert/fJes that a fully executed Endorsement, on a form authorized by the Department of Motor Vehicles (DMV). is lttached to the referenced policy, to conform the policy 10 the requirements of the Motor Garrlers of Property PermIt Act (Califomia! (ehl~e Code Section 34600 and following) and the Nles and regyl1'ltions of the DMV. (This provlsiqn does nqt apply to Worker$' >pmpensatlon Insurance.) , . lnsur-er agrees that this Certificate of Insurance snall not be canceled on less than thirty (30) days notice from the Insurer to the >MV, written on an authorized Notice of Canoellatlon form and that the thirty (30) day/period commences to run from the date oJ 1e Notloe of Canc&lIatlon was actually r9celve9 at the offioe of the California Department of Motor Vehicles, Motor Carrier Permit :ranoh in Sacramento, California. . Insurer agrees to furnish DMV-with a duplicate original of the referenced.policy, DMV al;ltho~zed endorsement, and alloth/:fr rlated endorsements Md documentation upon request. ,. Insurer agrees that for the purposes of Charitable Risk Pool Coverage that this policy meets the requirements of subdivision (b~ I the eve Section 16054.2. . . , y sIgning thIs form, the Insurer ct1rtifies under penalty of perjury under the ft'iW5 of the State of California that al1 tformation (;r>nta;ned in this Certificate of Insurance is true snrf porrect. =^:=:~","_~~,;~ENDALE' CA~~ J:;:-~f!f~~~ "'l V Il5 Me? (REV. 712002) ASSIsta l1 - ,'V -