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<br /> <br />DATE (MMlDDIVY) <br />9/13/2005 <br /> <br />PRODUCER <br /> <br />PHONE <br />(AIC,N9:. Extl <br /> <br />(818) 244-1144 <br /> <br />APPLICANT (First Named InlulWd) <br /> <br />BARTEL-ASSOCIATES, L.L.C. <br /> <br />JOHN SARGEANT INSURANCE AGENCY <br />P. O. BOX 831 <br />GLENDALE CA 91209 <br /> <br />411 BOREL AVENUE, SUITE #445 <br />SAN MATEO <br /> <br />CA <br /> <br />94402 <br /> <br />EFFECTIVE DATE EXPIRATION DATE COIPLAN <br /> <br />CODE: <br />AGENCY CUSTOMER 10 <br /> <br />SUB CODE: <br /> <br />POLICY NUMBER: <br />ACCOUNT NUMBER: <br /> <br />THE CITY OF SANTA ANA IS HEREBY NAMED ADDITIONAL INSUREDS ON POLICY NUMBER 72SBA AD2098 AS <br />RESPECTS OPERATIONS OF THE NAMED INSURED ONLY. SEE ATTACHED FORM CG 20 11. COVERAGE UNDER <br />POLICY NO: 72SBA AD2098IS PRIMARY & NON-CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE <br />CERTIFICATE HOLDER(S) AND ADDITIONAL INSURED(S) MAY CARRY. <br />10 DAYS NOTICE FOR NONPAYMENT OF PREMIUM. <br /> <br />APPROVED AS TO FORM <br /> <br />%5 3/r; <br /> <br />Laura Stid Sheedy <br />i\:o~ISiant City Attorney <br /> <br /> <br />LM: LPWv1.9.8 on 9/16105.16:25 by UserName <br /> <br />LP: LPW v1.9.8 on Qf16105. 16:25 by UserName <br />