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01/21/2005 09:24 7145714209 PARKS AND RECREATION PAGE 01 <br />din 04 05 O4t24p Garlock 1AS, HEeney rut QV -W- F000 F•. - <br />CERTIFICATE OF INDURANCA A-,-00`'-044 <br />TyaesnlRae4pat [J STATE FARM FIRS AND CASUALTY COMPANY, bloomfngtan, Illinois <br />L—F-WyMng <br />""- STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois , STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario <br />STATE FARM FLORIDA INSURANCE COMPANY, Winter Havel; Florida <br />.....f I VATS FARM LLOYDS, Oonas, Tensainsures Poll, '-'er for the ooverages Indicated below. <br />Name of policyholder CQ'g7iTNSCA'IICNS SUPPORT GROUP, INC. <br />Address of policyholder 505 Scenic Ave., Piedmont, CA 94611 <br />Location of operations <br />Description M operstianS <br />The policies listed below heV0 been <br />subject to all the terms atrelusions, <br />issued to the policyholder for the policy pWpde $hewn. The ihaurenee described In these policies is <br />and conditions of those policies. The limits of liability shown may 11" bean rW.Vo d by any Paid <br />poen m. <br />IKcc <br />AMEMM. 9XYENDS OR ALTERS THE MVEPA06 APPROVED YY ANY POLICY DESCRIBED HEREIN. <br />POLICY PERIOD <br />LIMiIM OF LUIBRITY <br />POLICY NUMBER <br />TYPE OF INWRANCE <br />E Data ; Dae <br />jet beginning W pollible Period) <br />9 -1 -MC -1176-4 <br />Comprattsnsivs 10124/04 7.0/24/ 5 <br />BODILY INJURY AND <br />no obll n or liabdgy will be Impcaa,I an sate <br />Ll ility._____._• <br />PROPERTY DAMAGE <br />...............'--- _.-_-__-__ <br />This InsurenCe InNudes: <br />_Business ••._ _ <br />'-------..-- ------........L.._...........,-- <br />Produons - Completed Operations <br />Parks, Reer:ation 6 coaarunity 3crvioce Agency <br />V�•� <br />® CoMTAotual Liability <br />aidnoure of Aulhot{LOd RepreselnelMs <br />fast Y, sant* Arta alvd. Suite 200 <br />® Underground HUOrd Coverage <br />Each Oeeurrenes S L.000,000 <br />Tay Dar9 <br />❑ Personal InlurY <br />AgsnreCodsasanp <br />Q Aovertlsing Injury <br />Gonoral Aggregate S 2, 000,000 <br />movATV F147 <br />3 Explosion Honed Coverage <br />Assistant City Attorney <br />® Collapse "a:erd Coverage <br />Pdaduote - Completed S EXCLUDED <br />❑ <br />Operations Aggregate <br />POLICY P OD <br />BODILY INJURY AND PROPERTY DAMAGE <br />EXCE88 LIABILITY <br />Ethmm" Dad :Empkadm Q890 <br />(Combined Single Limit) <br />❑ Umbrella <br />Eeon Occurron4Y S <br />❑ Other <br />Ngrecato S <br />Pert i STATUTORY <br />Pen 2 BODILY INJURY <br />Workers, Compensation <br />and Employers Liability <br />Each ACandem i <br />DIs91Re Eisen Employee S <br />Disease - Policy Lima S <br />LICY PERIOD <br />LIMITS OF L-IASiLITY <br />POLICY NUMBER <br />TYPE OF INSURANCE <br />Effeothls Daa ; expleadom Dad <br />a beginning of nod <br />I <br />-.-__-_-__—_-__._.____._�._..�-��-w"..-ww,.Move.or...=MhOn <br />-- <br />I <br />wccroMAYO V WAR Lrad.ATIVOIV <br />HRuAi C VF IMiVrwnvc w row A uvrs 1 a 1 Vr Ir.VVrYM.YG—nM-RYAr •---- ,♦—•- — <br />AMEMM. 9XYENDS OR ALTERS THE MVEPA06 APPROVED YY ANY POLICY DESCRIBED HEREIN. <br />If any of the described policies are canceled before <br />ds expiration date. SIM FS'M will try to mac a <br />written notice to the cartHlcate holder 39 days before <br />Name and Address of Csltlfloate Holder <br />cancellation, If however, ova fall to man Such notlCer <br />no obll n or liabdgy will be Impcaa,I an sate <br />ta9ARGD: <br />Farrn�l anly6r rap an aa. <br />City of Santo Ana <br />city Ste <br />Parks, Reer:ation 6 coaarunity 3crvioce Agency <br />V�•� <br />Attn: Dolerea RNaoe <br />aidnoure of Aulhot{LOd RepreselnelMs <br />fast Y, sant* Arta alvd. Suite 200 <br />AUNNT <br />D.O. Sox 1905 M-23 <br />Tay Dar9 <br />a.ne,. Ana CA 02,102 <br />APPROVED AS TO FORM <br />AgsnreCodsasanp <br />Kc"JJLQ,CK 2093 <br />s,sSa*wBNP.. h4*rdlnV.aA <br />movATV F147 <br />Laura S it Sheedy <br />Assistant City Attorney <br />