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To: City of Santa Ana From: Blanca Roque 10-04-05 10:35am p. 2 of 6 <br />ACOOR <br />o , �r o <br />��4L{ <br />, A .,` 3 <br />4+I, Irrl <br />� V� r., R m ��+. 10/4/2005 <br />Protlucer Blanca Roque <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />Wood Gutmann & Bogart Insurance Brokers <br />THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />COVERAGE AFFORDED BY THE POLICIES BELOW. <br />15901 Red Hill Ave., Suite 100 <br />Tustin CA 92780 <br />714 505.7000 <br />INSURER Hartford Insurance Company <br />www.wgbib.com <br />License No. 0679263 <br />A <br />INSURER <br />B <br />Insured <br />INSURER <br />Fieldman, Rolapp & Associates <br />C <br />INSURER <br />D <br />19900 MacArthur Blvd, #1100 <br />Irvine CA 92612 <br />r, a, <br />��(m..,,,. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICY <br />POLICY <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />EFFECTIVE <br />M IDDDAT YV <br />EXPIRATION <br />M DATE Y <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL Lim <br />72.SBAAF9892 <br />4/1/2005 <br />4/1/2006 <br />FIREOAMAGEAn tfln, $ <br />@09. CLAIMS MADE OCCUR <br />MED EXP ore arson E <br />PERSONAL& ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GENT AGO LIMIT APPLIES PER <br />PRODUCTS-COMP/OP AGG $ <br />$ <br />POLICY 7PROJECT MILOC <br />AUTOMOBILE LIABILITY <br />MY AUTO <br />72UECTQ4293 <br />4/1/2005 <br />4/1/2006 <br />COMBINED SINGLE UMH $ 1,000,00( <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per P.) $ <br />BODRV INJURY <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Per ..Ment) $ <br />PROPERTY DAMAGE <br />(Per a¢Ident) $ <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA PCL $ <br />ANY AUTO <br />AUTO ONLY: AGG$ <br />EXCESS LIABILITY <br />EACH OCCURRENCE $ <br />01 <br />OCCUR 7 CLAIMS MADE <br />72.SBAAF9892 <br />4/1/2005 <br />4/1/2006 <br />AGGREGATE $ <br />$ <br />DEWCT'mT <br />$ <br />RETENTION $ <br />WORKERS' COMPENSATION & <br />STATUTORY LIMIT I IDTHERT17",."k,¢, 4 <br />EMPLOYERS' LIABILITY <br />EL EACH ACCIDENT $ <br />72WBCNU7013 <br />4/1/2005 <br />4/1/2006 <br />EL DISEASE - EA EMPLOYEE $ <br />Is <br />EL DISEASE -POLICY OMIT <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as additional <br />insureds per attached SS 00 08 04 01. <br />, , h„ <br />' v ary^ ; 5,� , �•. 6 tl lL n, Pfd 1 wY� � � <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />City of Santa Ana <br />Attn: Clerk of the City Counsel <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />_aaQ—* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br />LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION <br />OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRE- <br />20 Civic Center Plaza (M-30) <br />Santa Ana CA 92702-1988 <br />SENTATIVES. 10 Days forNon-Pa .ant of Pramlum <br />AUTHORIZED <br />REPRESENTATIVE <br />Dan Gorman <br />„�,' <br />,VTtk�„ , <br />