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<br />F'RODI;c:e:R <br />PROWORKS iNSURANCE SERVICES,INC <br />LICENSE #{)063i5B <br />25550 HAWTHORNE BLVD. #305 <br />TORRANCE, CA 90505 <br /> <br />310-465-0200 <br /> <br />I <br /> <br />ACORD <br />. ~ <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />\tI!SUREO <br /> <br />GOLDEN STATE ELECTRIC <br /> <br />DENNIS TRAUTH <br /> <br />21342 CONRADI AVENUE <br /> <br />TORRANCE, CA 90502 <br />I <br /> <br />COVERAG~S <br /> <br />THE POUCIE::S OF INSURANCE. LIsTEn BELOW HAVE SEEN ISSUED TO THS INSURED NAMeo ABOVE FOR THE POLICY pg,RIOD INDICATED. NO"WITH~-- \ND1NG <br />ANY REQUI~~MENT. Tl:.f;1M OR CONDITION or ANY CONTRACT OR OiliER DOCUMENT YI/ITH RES~I:CT TO WHICH THIS GERTtPICATr. MAY Be: IS:IIED OR. <br />MAY PERTAIN. THE INSURANCE AFFOROED aY THE POUCIF;:;S DESCRI8~D HEREIN IS sueJEcr TO Al.1.. THE TERMS, EXCLUSIONS AND CONDITIONS (;I: SUCH <br />POI.IC1ES. AGGRE:GATEWA1TS SHOWN MAY HA,VE BEEN RE:OUCED BY PAID Cl.AIMS. <br /> <br />~{RIAOiJ' POLIcy NUM9ER. poucvi;:Ft CTIve POl,tcYEXPIRATlON <br /> <br />rNSU~.~R 0: <br />INSUReR E. <br /> <br />_._~_L-_" <br />. \ <br /> <br />U"""T!l <br /> <br />1( 00,000 <br />: 00,000 . <br />__H 5,000 <br />1 ,r 00,000 <br />?:i 00,000 . <br />J,t 00,009 <br /> <br />A <br /> <br />. GENE.RAl UAElILm <br />G-Xl COMIUIE~CI^LG,"NeFl:ALLlABILlTY <br />_~ ClAIMS MAOI;;: [K) OCCIJI'! <br /> <br />- --- ---- - <br />- --- <br />GEN'lAGC1~EGATE LIMIT A.F'F't.1E8 PER: <br />-Xl POI.,IOY - PRO. ' .~ lOC <br />I AUTOMOBILE LlA.Bll..,ITY <br />1 ANY Jl,UTO <br />Ar.l OWNED AUTOS <br />. ,5CHEDUlEDAUtOS <br />,..URED AVl"OS. <br />Nm.,hOINNEO MJTOS <br /> <br />WSR-000037 <br /> <br />05/09/2005 <br /> <br />0510912006 <br /> <br />EACH OCGUt"\RENCE t- <br />"Of(M^l..i~ I~Kt.N\tU . _.--- <br />I>R,~.~ISES @~.GU~rl5f)___ _.!.__. <br />ME.!:l~~~~~~~_!._ <br />PE.Fi:.SPN,oI,l & M)V ItJJl.!!!!'~_..!...._ ~ <br />.1135'NERAlAGG~EGATI:. ,$ <br />~~P~~.I.COMr>.1!?~~~J_ <br /> <br />I COM6INIDSIN<;.1.l: LIMIT ,; <br />(~ila<<'I(I"nll <br />.. -------.. ----...- <br />OOO\lYl!'lJUR"f E <br />(Ptrrpdr'>;dfl) <br />.-~- --- <br />!'DDll V INJURY S <br />(r'<ilr8CCldlJnt) <br />--~- ~-- <br /> <br />P~OPE.RTY tlJ..MAGE <br />(F~aecffJl!It'Il) <br /> <br />, <br /> <br />I aeeSS1IJMBRE!UA UAElIUlY <br />~- _] OCCU~ I._.J CLAIMS MACE <br /> <br />.' I <br />-~-- <br /> <br /> <br />1-.0 ~~\1 <br /> <br />~.W~,!,EAA~__ .S <br /> <br />OTHER THAN EA Ace ~!....-......-_. <br />WTOONl)': AGG .Ii <br /> <br />.~CH?E.~B"'e~~_. ..~~_,__ <br /> <br />, ^~_OR~_ .~_. <br /> <br />O~~G'E UA91lI'TY <br />AN)'^\JTD <br /> <br />DEDUCTISll<: <br />RETENTtON <br />WORKERS COMF'EN9PoTlON AND <br />EMPlOYE~' i..IPt,B1UTY <br />^NY PRQf'RIETaRt~^RTNl;~/El('ECUTlVE. <br />OffICERIME:M.!I:eR EXClUDfD? <br />~PEt~'r~R~~~1~NS b~1ow <br />( OTHE:~ <br /> <br /> <br />-~-_.. <br />.!~--. <br />. <br />~iltMHs.1 L~{~_..~. <br />, l<:.l._~~~~IDENT . So <br />E,J.. grsEASt:: ).!~ EMpl..OYEE t <br />E.l. DISEASE) POLICy LIMn " <br /> <br />OEscrUPTlON OF OPIOFtATJONs f lOCATtONS ,VEHIClES rEXCl,UtJ,oN'S ADDE.O e'l' l;f\tpaRSEME:NT f 9PECIAl PROVISIONS <br />THE CITY OF SANTA ANA, iTS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS <br />ADDITIONAL INSURED AS REQUIREO PER WRITTEN CONTRACT. <br /> <br />JOB: ELECTRICAL RE:PAIR <br /> <br />CERTIFICATE HOLDER <br /> <br />THE CITY OF SANTA ANA <br />ATTN: JESSE ALVIDREZ <br />20 CIVIC CENTER PLAZA #M16 <br />SANTA ANA, CA 92701 <br /> <br />CANCELLATION <br />SHOULD "'NY THE AGOV~ IJi:iSCRIBEO POUCIES Be CANCE;t.t.ED BE~OFl.~ THIl: E.lf RATION <br />DA~ TH EO~. I-IE 19~UING lN$UR~R. Wrl.L~~~)j;All, 30 DAY,s I fRlTTEN <br />NOTICE OTHE: ~T1n e L.DERNAM!ODTOttfl;;l.Enx;o~mtrr~ <br />;'E;PIi~~Xmil~~ <br /> <br />ACORD Z5 (20011081 <br /> <br /> <br /> <br />. ACORD CORPORA TICii Has <br /> <br />t.~ ' <br /> <br />(p.) <br />