|
<br />.JJE
<br />
<br />...I::' lU:::''"foHM
<br />
<br />Hi"' LHl;IoRJET FAX
<br />
<br />p.2
<br />
<br />MARSH RlSK RND INSURANCE
<br />
<br />949 399 2712
<br />
<br />P.02
<br />
<br />DEL- <.~ ~od05 10: 20
<br />,-MA.RSH
<br />
<br />CERtiFICATE OF INSURAN'C'E
<br />
<br />"JltODUCBt
<br />Marsh Risk a Insuraflce Service3
<br />41395 Mac'r1tuJr Court. Suite 700
<br />(949) 399.5800
<br />Llcen$e "00437153
<br />Ne*porl Btlach, CA 92880
<br />
<br />ClI!!flT''''IC'''! NII"UIt
<br />LOS-000498727-00
<br />1"11 C"EJllTI'.l;....UIS Il5l,1n AI A MAT"'A OJllNFO"",,,1)QH ONL'1' AND COHI'I!1II5
<br />NO PJOtlTS U,ON THe eEII"'~"TE HOLDIft l)TltER THAN THon 'R:OVlDED 1111"1
<br />rOUtT. THIS CC!JIlT.JC&n: Don /fOt ~NO, iEXTEND all AL'tf1f( 1Hf: COVEIUUJe
<br />AAlDIIIII!Il." TMt; Jl'OUC1!S DISCIt-.n HI!!"'I!IN.
<br />
<br />~~lIQE~ .'
<br />"'HI~ IS "1"0 CEA.'rIiJl'v THAT POUCt!S Off tNSU~e OfSCJttBEO HEAelH 1-t4.'I/E BEEN ISSuJ!D fO T,..I!! INSUFl:I!!O N.6J,IIEO He~Et"" FOR THE POLICY PEItIOO 11\.tl,CA."lb.
<br />NOTWITHSTANDING. ANY IE;QuIM.MeNl. TERM OR CO/II()ITIOt..r Of: ANY CONTRACT OR OTHEROOCu""'RHT \'YllH ResPl:!C i' o{o 'llll'iICH It-fE CERTlFIO.TE MAV M ISSuED 01'\ M/'..Y
<br />PfRTAIN. THE' 'NSUMHCE ""O'l:t)fO &Y 1'}f1! l"OUCIES DfSCAl8ro t4EAiEIH IS SVBJ!CT TO All TH! f!JI(MS. CONOl110NS AND EXCLUSIONS Of SUCH P'OuCII!S. AGG....~G"TE
<br />LIMITS SHO......N t.U.Y ""V~ &l!EI\I 'l\fouceo 8Y P'AIO et..AI,o.,a
<br />_ _________n_ ___. __..___ ____.__.___._h .______
<br />CO
<br />LT.
<br />
<br />_.A,.v.!<?.9.~~~_~'!l:~ $
<br />OTHI.Ilt THA/.l AUTO ONLY:
<br />-------------~_<I.CJ;IP.ft!~, S
<br />~QG.4.TE. $
<br />~ OCCUPUIlI!!NCe _. ~...._ .______~
<br />~GlItI.GATE $
<br />$
<br />X J TOI{y LIMITS I I ""Fl'
<br />n EACH ACCtOENT $
<br />Et D1SEASE-"OllC;Y UW'r S
<br />EL OI$U$E-EACtoI EMP"OVCE $
<br />
<br />SltOUllJ ulr 011 '"f. ,.oUCIl" ou:t.'UKO "UtIli 8.. CAt<lt:t:ll.ll~'E"OR.E TI1EDPIIIl'ATtOlol D4TE' THflt,~or.
<br />TI1Ii! IN~Ii!. "I'f'OItD...O e<lVJII.....( "'1~1. eloltltAVQIl: TO _.L ~ 0...... WIIIIT'TIl~ I'4CTICE 'n THE
<br />eall.111t1C1l1'J! 110LOU PMMtCO "EREIN, BUT F.AU/RI TO 111M. SIJCH NOTICE: IH4U IW'O.!l( NO 08.t.1(;ot.'ION 01\
<br />ut..'lITY IIr......, MWD> l.l'OJ'lTlit: ItlhllllEIIlA"Ol'C1fo1l1 CO'llE~CE, n::-'Ol!"'1S (III 1I1:,",,"-1;;I:IO""TI\I0. OR 'nil:
<br />I\IMII9"TIlI$C',""'~TI
<br />M.IlIH USA'..~.
<br />IV: Cheryl Schtoedtr
<br />
<br />; 'liIM'IJIOZ)
<br />
<br />~_O~P~'!!!:~A.~I?!.~~2.~~!'.G.!'.__
<br />
<br />, Z600--00-00-0'/05
<br />
<br />C(lUP.""",,"
<br />A Hartford Fire 'llSutliiloca Compan.,.
<br />
<br />fMJUIUD
<br />Griswold Indueb'ies
<br />CIa.VI!lII fne.
<br />1701 Plecenua AV8:nue
<br />Co.sla M..... CA 92627-4475
<br />
<br />COMPANY
<br />B NfA
<br />
<br />COMl'ANf
<br />C Hartford In.5urence Company of ""W
<br />._...__._.... ..... . __"_h' _._.___,______._.___ ___.___..
<br />OOMP'ANY
<br />D
<br />
<br />lYPI OF ....URANCI
<br />
<br />POUCY EFF"EeTIVIi POUCY ElCPlRATION
<br />OAT!! 'MIMl:DIYT) DATe (MNIDDIYYI
<br />
<br />l"""
<br />
<br />POUCY NU"II!R
<br />
<br /><lVlI!:IU.I.U"'lUTY
<br />A r-x- OOMMeRC1I\L GeNI!fU.l. u.tl81111'V
<br />:;i; , I ClAJUSJrMDE L'X' J OCCUR
<br />O'NNEFtS 6 CONTRAocrOA'S PROT
<br />)( <1 nnnonD "IB.____
<br />
<br />04I01/0a
<br />
<br />oeNE.fW, "CJORi~TE S
<br />r~OOUCT&.- COW"fO!t AGO, $
<br />~~~ IADV~~~.r". $ '. n.."_
<br />~CI1 OCC;URAENCE 'j
<br />FIR! DAMAGE r...." atleoJ;.~L_ ~.. _, ,
<br />MEO EXP ,_~. """"I $
<br />COMBINEO SINGLE I./MlT .s
<br />
<br />7Z!;CS0A18er
<br />
<br />~4101/D5
<br />
<br />AUtOMOBILE W81LITY
<br />-:-:-
<br />A ~. AHf AlfiO
<br />A _ .lJ.LOWNEOAUTO.s
<br />.!Cl-tI:OUl!!:D"UTOS
<br />X tt~EDAlJTl>S
<br />-"-x
<br />.-:..... NON.oWN~ .AUTOS
<br />
<br />72UI!NUM3'IW
<br />72UENUM3157 ~TX)
<br />
<br />04101105
<br />04/0'10~
<br />
<br />0'101/05
<br />04/01106
<br />
<br />BODeLYWJllRY
<br />(Petpet1;DIlJ
<br />
<br />MOlLY INJURY
<br />'f"ef.llcddBnl)
<br />. .-.---------
<br />1'Yll0f'1!1\1l DAMAGE
<br />
<br />O.AJl4G1! U4llUTY
<br />
<br />_ ANy....ura
<br />
<br />I
<br />C
<br />
<br />eJ:ces~ U.l&IJJTT
<br />h Ut.lBRElLA FOR",.
<br />r1 OTl-efltTHANUMBRELLA ,I)~,..
<br />I t;~""EI\S'L~~~'IOHANO
<br />
<br />floI1i PROPftfiTOIlf r;x~-I '..Hc:LCL
<br />PMTNEIIISfaX.eClITl\lliii
<br />OII'''Il:::eRS"ItI!;
<br />"'"'"
<br />
<br />04I01r06
<br />
<br />72WN-C93100
<br />
<br />04101/05
<br />
<br />oe'CR"'T10~ OF OflEJtATIO"'U.OC''''rIONIlYEHI(h''~PI4:rAlIT!M5
<br />RE: WOfk petformed for CHy 0' San1a ArIa, Addlllooslltlsuret1 End."" iltamed
<br />
<br />~~!, d //0
<br />
<br />, /
<br />
<br />.~~f~~~~T~;~~D'6R
<br />
<br />.. :
<br />
<br />. :C"'N~~t\'!'TIOhl
<br />
<br />The City 01 SDl1la Ana. itsoffioers
<br />employee,. 8l18'nm, volunleCf's. i1nd repreS8n1atlveo-
<br />20 CIVIC CerHer PLa.t&l
<br />Aft,,: CHy ~.rt<
<br />Santa Ana. CA 92r01
<br />
<br />:'p,'.:liL1. ':,1 I
<br />.,~.,.I'_"'-I
<br />J ~,:t.:..~'.~,'~:'
<br />
<br />':~>:"
<br />
<br />'\.,"
<br />
<br />VAuD AS OF: 12"10105
<br />
<br />....
<br />'. ..'. ~ - ,
<br />
<br />.. "
<br />
<br />- -.--....-
<br />
<br />1-
<br />
<br />-- .-.-.--....--...-
<br />
<br />Z.OOO,O~~
<br />2.000,000
<br />, .000,000
<br />, .000.000
<br />300,000
<br />
<br />1,OOO,ooa
<br />
<br />$
<br />
<br />s
<br />
<br />$
<br />
<br />.~; ..t:.:~'~~:~';
<br />
<br />'.' :i"~ :~~!'''~f
<br />
<br />1 ,coo, nOD
<br />1.000.000
<br />1.000.000
<br />
|