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<br /> ACORD, CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
<br /> 10/18/2005
<br />PRODucER (305)822-7800 FAX (305)827-0585 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Collinsworth, Alter, Fowler, Dowl ing ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />& French Group Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />P. O. Box 9315
<br />Miami Lakes, FL 33014-9315 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED W. Koo & Assoclates, INSURER A: Sentry Insurance a Mutual Compan A+ XV
<br /> a division of PBS&J INSURER B: Steadfast Insurance Company A XV
<br /> 2001 NW 107 Avenue INSURER c: Lloyds of London A XV
<br /> Miami, FL 33172-2507 INSURER D:
<br /> ~. ''': ) '}. -.)'J';j INSURER E:
<br />r:OVERAGES
<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 DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
<br /> GENERAL LIABILITY 90-15807-03 09/30/2005 09/30/2006 EACH OCCURRENCE $ 1,000,000
<br /> ...,.,..
<br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1,000,Ooe
<br /> I CLAIMS MADE m OCCUR MED EXP (Anyone person) $ 25,000
<br />A ~ Contractual Liab PERSONAL & ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,OOO,OO~
<br /> I--
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CDMP/OP AGG $ 2,000,000
<br /> ~ POLlCY m ~~8T [Xl LOC
<br /> AUTOMOBILE LIABILITY 90-15807-04 09/30/2005 09/30/2006 COMBINED SINGLE LIMIT
<br /> - 90-15807-05 (Ea accident) $ 1,000,000
<br /> ~ ANY AUTO
<br /> !. ALL OWNED AUTOS BODlL Y INJURY
<br /> $
<br /> SCHEDULED AUTOS (Per person)
<br />A X
<br /> HIRED AUTOS BODILY INJURY
<br /> X (Per accident) $
<br /> NON.OWNED AUTOS
<br /> -"- Contractual Liab
<br /> X PROPERTY DAMAGE
<br /> (Per accident) $
<br /> ==iGE LIABILITY AUTO ONLY. EA ACCIDENT $
<br /> ANY AUTO OTHER THAN EA ACC $
<br /> AUTO ONLY: AGG $
<br /> ~ESSJUMBRELLA LIABILITY AUC508762101 09/30/2005 09/30/2006 EACH OCCURRENCE $ 25,000,000
<br /> X OCCUR 0 CLAIMS MADE AGGREGATE $ 25 ,000,000
<br />B $
<br /> ~ DEDUCTIBLE $
<br /> X RETENTION $ ( $
<br /> WORKERS COMPENSATION AND 90-15807-01 09/30/2005 09/30/2006 X IT,:(9,,~T~,!<'J IOJ,!;"
<br /> EMPLOYERS' LIABILITY 90-15807-02 E.L EACH ACCIDENT $ 1,000,000
<br />A ANY PROPRIETOR/PARTNER/EXECUTIVE EL DISEASE. EA EMPLOYEE I,OOO,OO~
<br />OFFICER/MEMBER EXCLUDED? $
<br /> If yes, describe under NO E.L Ol€-EASE . PDLlCY LIMIT $ 1,000,00~
<br /> SPECIAL PROVISIONS below
<br /> .W"r. LDUSA0500811 09/30/2005 09/30/2006 $1,000,000 Limits
<br />C ro essional/ Ea Claim and Annual Aggregate
<br /> Pollution Liability CLAIMS-MADE FORM 11/11/1961 Retrodate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />e: 1st 5th Street & McFaden Avenue Bridge.
<br />anta Ana, City of Public Works Agency and City of Orange are named additional insured on the General
<br />iability, excluding professional services. Insurance evidenced by this certificate shall be primary
<br />nd non-contributory to that of the named additional insured; said coverage contains severability of
<br />'nterest provision. Issuing companies will provide 30 days written notice of cancellation.
<br /> --
<br />
<br />IF AT H 0
<br />
<br />Santa Ana, City of
<br />Public Works Agency
<br />Attn: Mindy Ly
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92707
<br />
<br />, )
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL~ MAIL
<br />I~'Ol M...1!l-DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />~K)(~lijllli\Jlil{~XX
<br />~lIJ(~JIl{lOOIltXli\K)(~XXXXXXXX
<br />- /~
<br />~./.::'4?/koif^#."/
<br />
<br />ORIZED REPRESENTATIVE
<br />
<br />
<br />Meade Collinsworth/EEC
<br />
<br />@ACORD CORPORATION 1988
<br />
<br />ACORD 25 (2001/08)
<br />r;.,Z.
<br />
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