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<br /> AroIm, CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY)
<br /> 10/13/2005
<br />PRODUCER (305)322-7300 FAX (305)327-0535 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Collinsworth, Alter, Fowler, Dowling 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: Ll oyds of London A XV
<br /> Miami, FL 33172-2507 INSURER 0:
<br /> INSURER E:
<br />r.OVE""'GE"
<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 />m ~ TYPE OF INSURANCE POLICY NUMBER P~HS~ EFFECTIVE P~~!fcY EXPIRATION LIMITS
<br /> ~NERAL LIABILITY 90-15307-03 09/30/2005 09/30/2006 EACH OCCURRENCE $ l,OOO,OOC
<br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ l,OOO,OO(
<br /> I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $ 25,000
<br />A ~ Contractual Liab PERSONAL & ADV INJURY $ 1,000,00(
<br /> GENERAL AGGREGATE $ 2,OOO,OO(
<br /> ~'~ AGG~EmE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,OOO,OO(
<br /> X PRO- ['Xl
<br /> POLICY JEer LOC
<br /> ~TOMOBILE UABILlTY 90-15307-04 09/30/2005 09/30/2006 COMBINED SINGLE LIMIT
<br /> 90-15307-05 (Eaaccidenl) , l,OOO,OO~
<br /> ~ ANY AUTO
<br /> X ALL OWNED AUTOS BODILY INJURY
<br /> -'-'- lPerperson) ,
<br />A X SCHEDULED AUTOS
<br /> HIRED AUTOS BODILY INJURY
<br /> X (Per accident) $
<br /> NON..()WNED AUTOS
<br /> -'t Contractual Liab PROPERTY DAMAGE
<br /> ~ (Peraccidenl) $
<br /> RGE LIABILITY AUTO ONLY - EA ACCIDENT ,
<br /> ANY AUTO OTHER THAN EA ACC ,
<br /> AUTO ONLY: AGG $
<br /> EXCESS/UMBRELLA LIABILITY AUC503762101 09/30/2005 09/30/2006 EACH OCCURRENCE $ 25 ,OOO,O~
<br /> t!J OCCUR 0 CLAIMS MADE AGGREGATE $ 25,000,OOC
<br />B ,
<br /> ::;1 DEDUCTIBLE ,
<br /> X RETENTION $ ~ ,
<br /> WORKERS COMPENSATION AND 90-15307-01 09/30/2005 09/30/2006 X I T")(9"ST~,~'o I 10J~-
<br /> EMPLOYERS' LIABILITY 90-15307-02 E.L EACH ACCIDENT $ 1,000,001
<br />A ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,001
<br />OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE ,
<br /> If yes, describe under NO E.l. DISEASE - POLICY lIMll . 1,000,001
<br /> SPECIAL PROVISIONS below
<br /> OTHl': . 1/ LDUSA0500311 09/30/2005 09/30/2006 $1,000,000 Limits
<br /> ro eSS10na Ea Claim and Annual Aggregate
<br />C ollution Liability
<br /> CLAIMS-MADE FORM 11/11/1961 Retrodate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />e: A50550.05 Santa Ana 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 />T
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL taitX~ MAIL
<br />2L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />~KK~llllli\lllt~XX
<br />~llK~)(d(lIJllOOlltIlli\KJ(liOOlllillllOOOOlXXXXXXXXX
<br />AUTHORIZED REPRESENTATIVE~"ij':"._~:'J_0.~/
<br />Meade Collinsworth EEC
<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 />@ACORD CORPORATION 1988
<br />
<br />ACORD 25 (2001/08)
<br />
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