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<br />~.,- CERTIFICA. OF LIABILITY INSURAaE I
<br />A CORtJ", DATE [MIlIIDDIYVVY)
<br />7/20/2004
<br />PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Venbrook Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />22801 Ventura BlvdJ Third Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />Woodland HIIII, CA 91364 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Phone 818.;Z25o-8200 FIX 818-:z;zs.a;Z10
<br /> INSURERS AFFORDING COVERAGE NAIC.
<br />IHSU'RED Overland, Paellle & Cutler, Inc. INSURERA, areat American E & S Company
<br /> 100 Welt Broadway "",URER a, The Hartford Inluranee Company
<br /> Suite 500 INSURERe, Everest Nationallnlurance
<br /> Long Baach, CA 90802 INSURERC, illinois Union Insurance Company
<br /> I INSURER'" RSUllnd.mnltv Comoanv
<br />
<br />CDVERAGES
<br />
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POliCY PERIOO INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE tssUED OR
<br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POliCIES DESCRIBED HEREiN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS.
<br />,'IN;: r.:~':1 "",.n. POUCYNUIIBER POUCY l!.",.ECTlVE POLlCYEXPlRATIOH LIMITS
<br /> ~NER.Al. UABIUlY :ECURRE.NCE . 1,000,000
<br /> X COMMERCIAL GENERAL LIABILIlY PL 5574310-01 6/24/2004 611/2005 $ 50,000
<br />A I ClAIMS MADE. 00 OCCUR MED EXP fAn" one oeraonl . Excluded
<br /> - F'ERSONAL & ADV INJURY . 1,OOu,OOO
<br /> - OENE.AAl.AGGREGATE . 2,000,000
<br /> ~'LA~nE L1I.1T APnlPER PRODUCTS. COMPJOP AGO . Excluded
<br /> POLlCY p~ lOC
<br /> ~O"OIIL! UAIIILJT'( COMBINED SINGLE LIMIT . 1,000,000
<br /> ANY AUTO 72 UECUM6536 6/24/2004 6/2412005 (EI ~,"I)
<br /> -
<br /> C- ALL OWNED AUTOS aOOlL'r' INJURY
<br />B (Perpet'Ulnl .
<br /> 7 SCHEDUlED ...urns
<br /> .,IRED AUTOS BOCJl.YINJURY
<br /> X- $
<br /> NON-QWNEO AlJTOS (Perscddent)
<br /> -
<br /> ~ROPE.RTY DAJr.1AGE $
<br /> (Per accident)
<br /> =r'~UTY AUTO ONLY. EA ACCIDENT .
<br /> ANY Avro OTHER THAN ...^"C .
<br /> AUTO ONLY: AOO .
<br /> ~~ISIlJMBRELLA UABIUTY EACH OCCURRENCE . 1,000,000
<br /> X OCCUR 0 CLAIMS MADE NHA212256 71912004 61112005 AGGREGATE I 1,000,000
<br />E I
<br /> R"'"""".'"" I
<br /> RETENTION . .
<br /> WOftK9.8 C(HI~SATlDN AND 3900048305-041 611/2004 6/1/2005 X J ,we STATU', I IO.Jr'
<br /> EMPLOYER$" LIABIUT"f . 1 ,000,000
<br />C ANY PROPRIETORIPARTNERlEXECUTIVE E.L EACH ACCIDENT
<br /> OFFICERlNEMBER EXClUDED? YES E.L DISEASE. EA. EMPLOYEE I 1,000,000
<br /> ~ffii~lS~ be~ E.l.. DISEASE. POLICY UMlT . 1,000,000
<br /> ~~oym.nt Practlcel Llab .. BM120010437 6124/2004 6/1/2005 EPL: $1,000,000 - $15,000 R.tentlon
<br />0 En-a... & Oml,,'onl Prof Llab E & 0: $2,000,000 - $50,000 R.tenllon
<br />DeSCRIP1X)N or OPI!RA.TIONSI LOCATJONa IVEHtCLES I EXCLUSIONS ADDeD BY 9DOIIlSl:MENT /8PECloI.l. P"- 'V IHJ AS TO FORM
<br />'10 Days Notlca of Cencellatlon for Non-Payment of Premium' Y~o.:~"o11 /h
<br /> v Laura Stitt S~:ttt
<br /> AS,sJIHant City A r:'ley
<br />CERTIFICATE HOLDER Addltlona. Insurea CANCELLATION
<br /> CI% of Santa Ana SHOULD MY OF lHI A8OYI! DeSCRIBED PDLlCICS II! CAHCEL.LED I5EP'ORE THE DPlltA110II
<br /> Pu IIc Works D.partm.nt DAT!. THEREOF, THE iSSUlNO INSURER WLL. BilDEAYOfIl; TO IIAIL~ DAYS WRITTEN
<br /> Attn: Tal~ Hlgglnl NOTll::1I!: TO 11iI!! CI!:RTIRCATE HOLDEIt NAM~D TO THE LUT, BI,IT FAl~1!! TO DO 80 ~
<br /> 20 Civic .nter Plaza
<br /> Santa Ana, CA 112701. IIIPOR NO OBlIGATION OR UAIlIUTY Of IJI'f KIND UPON THE INSURER, ITS AG.!NTS OR
<br /> IIEPItESI!!NTATI"~S.
<br /> AUTHORlZI!D R!PR9!!NTATlVE
<br /> \--l....J. . ...... l.~ ^" J.. "')
<br />ACORD 25 (2001/08) uvc,n ........... nO .-- <ClACORD CORPORATION 1988
<br />
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