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<br /> .-, CERTIFICA. OF LIABILITY INSURA.E I
<br />ACORD~ DATE (MMIDDNYYY)
<br />7/20/2004
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Venbrook Insurance 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 />Phon. 818-225-6200 Fax 818-225-6210 .
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Overland, Pacific & Cutler, Inc. INSURER A: 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 Illinois Union Insurance Company
<br /> INSURER D:
<br /> , INSURER E: RSUllndemnitv Companv
<br />
<br />COVERAGES
<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 />INSR ~~~~ ~.c ^c, POLICY EFFECTIVE P~~!f."Y EXPIRATION
<br /> POLlCY NUMBER LIMITS
<br /> ~NERAL LiASIUr{ EACH OCCURRENCE ! 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY PL 5574310-01 6/24/2004 6/1/2005 ~~~:-;~~YE~~6~~nca\ $ 50,000
<br />A 1 CLAIMS MADE [K] OCCUR MED EXP (Anv one person) . Excl uded
<br /> - PERSONAL & ADV INJURY . 1,000,000
<br /> - GENERAL AGGREGATE $ 2,000,000
<br /> ~'~AGG~En LIMIT APnS PER: PRODUCTS - COMP/OP AGG . Excluded
<br /> POLICY ~~9; LOC
<br /> ~OMOB1LE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> ANY AUTO 72 UECUM6536 6/24/2004 6/24/2005 (Eaaccidenl)
<br /> -
<br /> - ALL OWNED AUTOS BODILY INJURY
<br /> .
<br />B SCHEDULED AUTOS (Per person)
<br /> -
<br /> ~ HIRED AUTOS BODILY INJURY
<br /> X (Per accident) $
<br /> - NON.()WNED AUTOS
<br /> - PROPERTY DAMAGE $
<br /> (Peraccidenl)
<br /> ==rGE LIABIUTY AUTO ONLY - EA ACCIDENT .
<br /> ANY AUTO OTHER THAN EA ACC $
<br /> AUTO ONLY: AGG .
<br /> OOESSlUMBRELLA LIABILITY EACH OCCURRENCE . 1,000,000
<br /> X OCCUR D CLAIMS MADE NHA212256 i /9/20N 6/1/2005 $ 1,000,000
<br /> AGGREGATE
<br />E $
<br /> R ccuec ""'0 ,
<br /> RETENTION $ $
<br /> WORKERS COMPENSATION AND 3900048305-041 6/1/2004 6/1/2005 X-c~sT~~,~< I IOJb'-
<br /> EMPLOYERS. LiABILITY $ 1,000,000
<br />C ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT
<br /> OFFICER/MEMBER EXCLUDED? YES EL. DISEASE - EA EMPLOYEE $ 1,000,000
<br /> ~~~~I~tS~~~~s1orNS below EL. DISEASE - POLICY LIMIT . 1,000,000
<br /> g~~royment Practices Liab & BMI20010437 6/24/2004 6/1/2005 EPL: $1,000,000 - $15,000 Retention
<br />D Errors & Omissions Prof Llab E & 0: $2,000,000 - $50,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PR . .un A:, TO FORM
<br />'10 Days Notice of Cancellation for Non-Payment of Premium'
<br /> ;({~L\,ry,~r
<br /> L~L:fa SLU ~Lv l1 -
<br /> ^~:;'lsla,H City AlfJr:;Cy
<br />CERTIFICATE HOLDER Aaaitionallnsured
<br />
<br />CANCELLATION
<br />
<br />City of Santa Ana
<br />Public Works Department
<br />Alln: Taig Higgins
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701-
<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 WRITTEN
<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 />ACORD 25 (2001/08)
<br />
<br />
<br />1--1
<br />
<br />1--1. 0-
<br />
<br />@ACORD CORPORATION 1988
<br />
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