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<br />IDA TE (MMlDDIVY) <br />7-1-05 <br /> <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />ACORD.. <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />PRODUCER <br /> <br />PHILIP B. ROBINSON INSURANCE <br />2081 BUSINESS CENTER DR. # 200 <br />IRVINE, CA 92612 9494749300 <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />INsUiiEo-- -------- )T=-.;?oC6~C>I&;--~;URER"AMERICANSTATE-SINSURANCECO:- -_- <br />MORELAND & ASSOCIATES ;t -;;{t;oS-O'fD -,NSURER B PHI:LADELPHILINDEMNITLINS CO '__ ___ <br />1201 DOVE ST # 680 A CC_' _ I I'NSUAER,,-- _ _ __ ___ _ __ _ _ ___ __ <br />NEWPORT BEACH, CA 92660/r-;uo"" O'fD {) .'NSURER"'-_ _ _ _ __ ___ _ ____ <br />--- <br />949-221-0025 "NsuAERE, <br /> <br />COVERAGES <br /> <br />"THE POUC1ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERT~.I~J, THE 1r>.ISURANCE AFFORDED BY THE POLICIES DESCR18ED HEREIN IS SUBJECT TO ALL THE TEAMS, EXCLUSIONS AND CONDlTJONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br />I~SA - TYPE OF INSURANCE '~- . -- ..o~~ ;~;~- . ---liOpcY EFfEcTlVE- <br /> <br />GENERALUABIUTY 02B0769819 3-26-05 <br /> <br />A \-./ -~~~~MERCIAL GENER~_ UAgILl1Y I <br /> <br />I _ I _ .J CLAIMS MADE l_./i OCCUR <br /> <br />fi _n_ <br />-IJEBL_ n___ <br />I_GE~'L AGGREG~~.L1MIT APP~I~_PER <br />r POLICY P~OT ./ LOC <br />r-AU'1"OMOBILE UABIUTY <br />I I ANY AUTO <br />- , <br />; , ALL OWNED AUTOS <br />!i SCHEDULED AmOS <br />A 1-1 ~I HIRED AUTOS <br />- J---, NON-OWNED AUTOS <br /> <br />H <br /> <br />~~~AGE UABIUTY <br />I ANY AUTO <br /> <br />I <br />\ <br />02B0769819 <br />I <br /> <br />I <br />I <br />1 <br />1 <br />\3-26-05 <br />1 <br />I <br /> <br />EXCESS LIABIUTY <br />A ~,j " OCCUR r -- -1 CLAIMS MADE <br />r <br /> <br />01CT001899 <br /> <br />13-26-05 <br />1 <br /> <br />DEDUCTIBLE <br />RETENTION $ <br />I WORKERS COMPENSATION AND <br />EMPLOYERS' UABIUTY <br /> <br />AI <br />I <br /> <br />1 <br />4-1-05 <br /> <br />01WC027275 <br /> <br />O",ER <br /> <br />B PROFESSIONAL <br /> <br />PHSD094821 <br /> <br />14-1-05 <br /> <br />DESCRIPTION OF OPERATIONSlLOCATJONSlVEHICLESlEXCW$lONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> <br />POUC:Y EXPlRATIO--rr- <br />DATE M DD <br />13-26-06 <br /> <br />I <br />1 <br />I <br />I <br />I <br />13-26-06 <br /> <br />13-26-06 <br />1 <br /> <br />4-1-06 <br /> <br />1 <br />4-1-06 <br /> <br />UMITS <br />~eH oeeuRRENeE_ .~ lLO QQ, .0 0 0 <br />f.IRE.DAMAGE (Anyone fire) $1, 000, 00 q <br />__. ____ .__..__ __.._ _.___ u___. ._ <br />_ ME~ ~~(~ny_one pe!!J~L j_ ~ l_Q_t 900____ <br />r:E~.~ON~& ADY I~JURY __ $1.1..0. __~Q.., 900...._ <br />f-"-ENERAL AGGREGAlE . ,~ 0 0 0 , 000 <br />PRO~UC;S ~ COMP/OP ~G~---t-$-l , - 0 0 0 ~6 - b- <br />--- ---' -- .~. .-' --- --' ..----- <br /> <br />COMBINED SINGLE LIMIT <br />~.a~l;ident)__.__ <br />lBO OILY INJURY <br />(Per person) <br />-- ..-- <br />I BQDIl'( INJURY <br />~racClde~t)_ <br /> <br />1'1 000,000 <br />T,L_- <br />, <br /> <br />- --1- ---- <br />, <br />- t- <br />PROPERTY DAMAGE <br />(Per accident) <br /> <br />I' <br /> <br />rA~TO 2NL~AACCIDE._~_:~ <br />I OTHER THAN !A ACC '1-~ <br />AUTO ONLY: AGG $ <br />~~~~QCC~RREN~ _1_!lL~Q9-_L990 <br />I AGGREGATE_ ,1,000,000 <br />r -=\,-~=-_=--= <br />1_ __ _ _-+,_ _ <br />, <br />I r j we STATU- ,0"'. <br />'V TORY LIMITS ER ' <br />- E.L'_~~!i ~CClD~~~ __l--ir-;_ b 0:0 , O:9Q- <br />~E.~.~~~EA EMPL?YEE '$1 ,_Q9QL OQ9 <br />, E.L. DISEASE - POLICY LIMIT $1 000 000 <br /> <br />2 000 000 <br /> <br />CPA * IF CANCELED FOR NONPAYMENT 10 DAY NOTICE WILL BE G~'JfPROVED 1\8 1'0 I'ORM <br /> <br />CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED <br /> <br />ALL OPERATIONS <br />CERTIFICATE HOLDER ';,,[ ADDITIONAL INSURED; INSURER LETTER; A <br />CITY OF SANTA ANA <br />PO BOX 1988, M-17 <br />SANTA ANA, CA 92702 <br />TTN - MIRELLA VARGAS <br /> <br />'g)/ <br />// :~-i.2r<_._~_i<- <br />"Laura Stitt Sh: <br />CANCELl.ATION AS'i>1staal. Cil Al inr;J~' <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAnoN <br />DATE THEREOF, THE ISSUING INSURER WILL 11..._...... ,l. MAil ~ DAYS WRnTfN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT I' II::l:JRr .^ "'^ "^ C>I,IALL <br /> <br />Flt:ntul:N'", "...:$;- <br /> <br />1f.1t'V:tt: NU u........."....~ 51. ~.....,I.1I1 Vr" ....' ..JIIS "P'iltl "qlli J1I91:l-~^ <br /> <br />~ 4t:!~...TCl: OR <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />ACORD 2S-S (7/97) <br /> <br /> <br />@ACORD CORPORATION 1988 <br />