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<br />ACORD~
<br />
<br />CERTIFICA.OF LIABILITY INSURA.E DATE7~~M;~~:t
<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 />PRODUCER
<br />Venbrook Insurance Services
<br />22801 Venlura Blvd, Third Floor
<br />Woodland Hills, CA 91364
<br />Phone 818.225-6200 Fax 818.225-6210
<br />
<br />INSURED
<br />
<br />Overland, Pacific & Cutler, Inc.
<br />100 West Broadway
<br />Suite 500
<br />Long Beach, CA 90802
<br />
<br />INSURERS AFFORDING COVERAGE
<br />INSURER A' Great American E & 5 Company
<br />INSURER B: The Hartford Insurance Company
<br />INSURER c: Everest National Insurance
<br />INSURER D: Illinois Union Insurance Company
<br />INSURERE: RSUllndemnit Campan
<br />
<br />NAIC#
<br />
<br />COVERAGES
<br />
<br />
<br />THE POLICIES 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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />'~~: ~~~; POLlCY NUMBER POLlCY EFFECTIVE POLICY EXPIRATION LIMITS
<br /> ~rleRAL LiABILITY EJ\CH OCCURRENCE , 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY PL 5574310-01 6/24/2004 6/1/2005 ~~~~i~oE~~~~nCe\ $ 50,000
<br />A I CLAIMS MADE [K] OCCUR MED EXP (Anv one person) $ Excluded
<br /> - PERSONAL & ADV INJURY $ 1,000,000
<br /> - GENERAL AGGREGATE $ 2,000,000
<br /> ~'~ AGG~En 11IMIT APnS ~ER: PRODUCTS - COMP/OP AGG $ Excluded
<br /> POLICY ~~,Q;. lOC
<br /> ~OMOBlLE lIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> ANY AUTO 72 UECUM6536 6/24/2004 6/24/2005 (Eaaccident)
<br /> -
<br /> - All OWNED AUTOS BODilY INJURY
<br />B (Per person) $
<br /> SCHEDULED AUTOS
<br /> X HIRED AUTOS BODILY INJURY
<br /> f-)( (Per accident) $
<br /> I-- NON-OWNED AUTOS
<br /> r- PROPERTY DAMAGE $
<br /> (Per accident)
<br /> RGE UAOILITY AUTO ONLY. EA ACCIDENT $
<br /> ANY AUTO OTHER THAN EAACC $
<br /> AUTO ONLY: AGG $
<br /> t!]ESSJUMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> X OCCUR D CLAIMS MADE NHA212256 1/9/?OC4 6/1/2005 $ 1 ,000,000
<br /> AGGREGATE
<br />E $
<br /> R ,,"uwe ""," ,
<br /> RETENTION $ $
<br /> WORKERS COMPENSATION AND 3900048305-041 6/1/2004 6/1/2005 X I.WCSTATU- I IOJ6'-
<br /> EMPLOYERS' LIABILITY $ 1,000,000
<br />C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
<br /> OFFICER/MEMBER EXCLUDED? YES E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br /> If yes, describe under $ 1,000,000
<br /> SPECIAL PROVISIONS belOW E.L. DISEASE - POLICY LIMIT
<br /> gTHER BMI20010437 6/24/2004 6/1/2005 EPL: $1,000,000 - $15,000 Retention
<br />0 mployment Practices Liab & E & 0: $2,000,000 - $50,000 Retention
<br />Errors & Omissions Prof Liab
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PR ,)Ygl) f.;" TO FORM
<br />'10 Days Notice of Cancellation for Non-Payment of Premium'
<br /> G4
<br /> {~Cl,CJ~r
<br /> Ln.:ra Slott Sl..... II -
<br /> ^Sc.iSla;lt City Alf)r:,Cy
<br />
<br />CERTIFICATE HOLDER Additional Insured
<br />City of Santa Ana
<br />Public Works Department
<br />Altn: Taig Higgins
<br />20 Civic Center Plaza
<br />Santa Ana. CA 92701-
<br />
<br />CANCELLATION
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRmEN
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />~
<br />
<br />J-.-1.
<br />
<br />ACORD 25 (2001/08)
<br />
<br />e
<br />
<br />o e
<br />
<br />@ACORD CORPORATION 1988
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