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<br />.te: 9/1/2005
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<br />Time: 9:21 AM
<br />Page: 002
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<br />To: City of Santa Ana @ 9,1-714-647-6930
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<br />I ACORQ
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<br />CERTIFICATE OF LIABILITY INSURANCE
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<br />DATE [_O~ff\'Y")
<br />
<br />09/01/2005
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<br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATIOI~ I
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />'L HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I
<br />AL fER THE COVERAGE AFFORDED BY THE POLICIES BELO~~_-i
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<br />INSURERS AFFORDING COVERAGE ! NAtC N i
<br />~i~---~~------- _~n_____--+-_~~___~__I
<br />,;r,':"..r......:~'., Travelers Indetmity Company :
<br />-:~;;~c:, ~-fra ve 1 e rs P roperty-'i Casual t yInfCo-'--~--'---' 1
<br />: Ir~S;j"-:F\: Travelers Indemnity Co of Il: -~
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<br />
<br />i 'ACOUCER (916)443 0200 FAX (916)443-0251
<br />I' Owen Dunn Insurance Services
<br />License Number: 0670167
<br />] 2831 G Street Suite 200
<br />I Sacramento, CA 95116-3721
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<br />I HI Lathrop Way . .
<br />I' Sacramento, eA 95815 N-;J.OO'-/ -/,)0 .
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<br />Exn04A197' 07/01/2005
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<br />: '"-, ['!"EA~E. POLIC, UMIT 1,000,00
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<br />i WORKERS COMI"ENSATION AND
<br />: EMPLOYERS' LlABlllT'f
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<br />'E'5C~I"TIONOF Ol"E~TION$llOCATlONSIVEHIClESJ EXClL.5DN$ '-ODE flYEN[!Q fL. tNt!l~~s
<br />e: Test Rental Services ' A~,; i:-:ti.:fJ( ':lty Attnr.;l~J
<br />eneral Liability Blanket Additional Insured enaorsement per attached CGD246 1002
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<br />"'upon nonpayment of premium, 10 days notice of cancellation will be given.
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<br />C~RTIF-ICATI; 1-101 m:i:l
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<br />Citv of Santa Ana
<br />Personnel Se~vices, M-24
<br />Attn: Waldo Barela
<br />P.G. Box 1938
<br />Santa Ana, CA 92702-1988
<br />
<br />SI-IOULCr ANV::lr TIoII;' ASOV;;: :lESC'lIBED POLICiES Eli: CANCELl.ED BEFORE THE
<br />i<:'!P'RATION DATE THeRE~F, T"'IE ISS~ING INSURER WLL ~~ MAil
<br />~ DA'r:S WR.TTEN NO"'lce TO THE CER~FICAT" MOI.Diflll NAMIiO TO THe lEFT
<br />K~~_JllIIOOI->>OOllll~(IIl(~XXX
<br />-:lOOI\XltIil(~~I___D;XXXXXXXXX
<br />
<br />ALJTHCltUZEO REPRESIO'NTATIVE
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<br />ACORD 2'12001108) FAX: (714 )647-6930
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<br />~ar anne ~ovak/LLR
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<br />@ACORDCOF!PORATION 1';88
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