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<br />, . . '.\i CERTIFICA. OF LIABILITY INSURAaE I
<br /> A CORB,. DATE (MIlIIDDI't'YVY)
<br /> 712012004
<br />P"CXlUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Venbrook Inauran.ce Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />22801 Ventura Blvd, Third Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />Woodland Hills, CA 91364 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Phone 818-225-6200 Fax 818-225-6210
<br /> INSURERS AFFORDING COVERAGE NAIC.
<br />INSUftl:D Overland, Paclllc & Cutler, Inc. INSURER" Great American E & S Company
<br /> 100 West Broadway INSURER B. The Hartford Insurance Company
<br /> Suite 500 INSURER c, Everest National Insurance
<br /> Long Beach, CA 90802 INSURER 0, Illinois Union Insurance Company
<br /> I INSIJREREo RSUllndemnlty Company
<br />
<br />COVERAGES
<br />
<br />THE POliCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD f<DICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA.Y BE ISSUED OR
<br />MAY PERTAJN. THE INSURANCE AFFORDED BY THE POliCIES DESCRIBED HEREiN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY FJAlD CLAIMS.
<br />IIIN~ r..~'1., TV" n. POUCY NUMBER POLICY EFP'EcnYE POLICY EXPIRATION UIIITS
<br /> ~NERAL LIABlUTY ~CURRENCE . 1,000,000
<br /> X CQPNoleRClAl GENERAL LIABILITY PL 5574310-01 6/24/2004 6/112005 $ 50,000
<br />A I CLAIMS w.DE [!] OCCUR "'EO EXP (Any on. ~n1Q!'1l . Excluded
<br /> - PERSONAL & ADV INJURY $ 1,000,000
<br /> r- GENERAL AGGREGATE . 2,000,000
<br /> ~LAGG~nUUIT APnIPER: PRODUCTS. COMPJOP AGO . Excluded
<br /> POlICY p~ lOe
<br /> ~OMOBIU! UAIIUTY COMBINED SINGLE LIMJT $ 1,000,000
<br /> MlY AUTO 72 UECUM6538 6/24/2004 6/24/2005 (EII.ccldtn1)
<br /> f-
<br /> C- ALL OWt>ED AUTOS BODILY INJURY
<br />B (Pllrpenon) .
<br /> SCHEDUlED AUTOS
<br /> r-x HIRED AUTOS BODilY INJURY
<br /> X $
<br /> NON-QWNED AUTOS (Per accident)
<br /> -
<br /> PROPERlY DAMI\GE .
<br /> {Per acclclent)
<br /> =rG'~UTV AUTO ONLY. EA ACCIDENT .
<br /> fl,NYALm) OTHER THAN """"0 .
<br /> AUTO ON!. Y: Aoo .
<br /> ~~IIIIItELI.AUAINUTY EACH OCCURRENCE . 1,000,000
<br /> X OCCUR D CLAIMS MADE NHA212258 '19/2004 6/1/2005 $ 1,000,000
<br /> AGGREGATE
<br />E I
<br /> R=;;: $
<br /> $ $
<br /> WORKERSCOMPEHSATIOHAND 3900048305-041 6/1/2004 6/1/2005 X I~.$TATU',I IO~.
<br /> EMPLOYERS' UABlUTY . 1,000,000
<br />C ANY PROPRIETORJPARTNERlEXE:CUTIVE E.L EACH ACCIOENT
<br /> OFFICERJNEMBER EXClUOED? YES E.L DISEASE. EA EMPLOYEE $ 1,000,000
<br /> ~~,~'bvlS~ below E.L. DISEASE. POLICY UMIT $ 1,000,000
<br /> ~"roym.nt Practlc.s LIIb .. BMI20010437 6/24/2004 6/1/2005 EPL: $1,000,000 - $15,000 Retention
<br />D Errora & Omlnlon. Prof lllb E & 0: $2,000,000 - $50,000 Retention
<br />DESCRIPTION ~ OP!RATIOH51 LOCAllONS IVEHlCLES IEXCLUSlONS ADDED BY I!NDOflSIe'MeNT 18PEClAL PR ,y G<IJ AS TO FORM
<br />"10 Days Notice of Cancellation for Non-Payment of Premium" ".;I~o., CJ.. /) o~. /) } .
<br /> v Laura Slitt S~~,
<br /> As.sislant City A C:'ley
<br />CERTIFICATE HOLDER AGGllIonal InsUreu CANCELLATION
<br /> CIZ of Santa Ana IHOULD AMY OF THI MOYI! DeSCRIBED POUCICS I~ CANCEL.I.BI DUDRE THe EXPIU.TION
<br /> Pu lie Works Department DAT!. TMEREOF, THE "UlHQ INSURI!R WLL. ENDEAVOR TO IIAIL~ DAYS WRITTEN
<br /> Attn: TalE Hlggine KOTIe! TO THI! C!RTIRCATE ItOLDI!II NAMIe'D TO THE LUT, BI,IT "AlLURe; TO gO 80 aKALL
<br /> 20 Civic enter Plaza
<br /> Santa Ana, CA 112701- 1MP08I! NO OBl.IGATION OR l..IAIlIUTY Of ANY KIND UPON THE INSURER, ITS AO!NTS OR
<br /> III!PRESENTATllfE5.
<br /> AUTHORlZI!D R!PRUJ!HTATNE
<br /> i ~..~. , ..... 1...... ,..: J. .~
<br />ACORD 25 (2001108) VYCl<l (;a"".. nO -- ClACORD CORPORATION 1988
<br />
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