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<br />Oct 27 05 03:12p <br />08/28/2005 13:38 FAX <br /> <br />Cit~ of Santa Ana PWA <br /> <br />714-847-5089 <br /> <br />p.3 <br /> <br />lit 003/005 <br /> <br />IMPORTANT <br /> <br />If !he certlllC8le holder It an ADDITIONAl. INSURED, !he pol!cy(les) must be endOrsed. A slaltment <br />OIl IIlI$ C81tillc8le dcJes not confer rights to the cllltbllt hold.., jn IIGU 0' alld1 GfIdon18manl(a). <br /> <br />If SUBROGATION IS WAIVED, subjeollllthe 181ms snd CGIldltiOna cif \h.. pollcy, certain poI\c1n Ill8Y <br />requlnl an endorHmanL A stat.mer1I OIl tills certlftcate does not ccinre, I%1hle. 10 1M CIlr1lllcale <br />holder In I8Il 01 such endoraement(s}. <br /> <br />DISClAIMeR <br /> <br />The cer1lfioBle 0( Imll.nnce on the reversa ckle 0( lllls, form does not oonstkule 8 contract between <br />!he ia8!Jing lnslnlts). eutl1Qoized representaUve 01 "",due.... end the cltfllllQlle holder, net do.. " <br />~Iy or negatively &mInd. e;l(tend Of altel' the .",",,'ge aWorded by file pollciee ~ thereon. <br /> <br />Al'I'ROVED AS TO FORM <br /> <br />~5 2/:; <br /> <br />'Laura StiLL Sheedy <br />Assil:;tant City Attol'ney <br /> <br />ACORD 21S-$ (11&7) <br />