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<br />,- A CORD CERTIFICATE OF LIABILITY INSURANCE I o...nl~""D~1
<br />,. 03/07/2001
<br />'fl.OO\JCli:!( (GS'O)341p4484 FAX (650)J41-446\ THIS CERTifiCATE IS ISSUEOAS A MATTER OF INFORMATION
<br />Business Professional Ins. Assoc. Inc. ONLY AND CON~ERS NO RIGHTS UPON THE C;ERTl~'CALE
<br />HOLDER. THIS CERTIFICATE DOES NOr AMEND, EXTENO OR
<br />i519 South B Street Al TE~ TI-fE COVERAGE AFFORDED BY fHE POUCJfS BELOW.
<br />Sah Mateo,. CA 94402 INSURERS A~FOR01NG COVERAGf;
<br />lHSOR.EO Imtran. Inc fNSU~fR A Hartford
<br />Z0331 Lake Forest Or1ve #C6 IHSURfR8 rIG
<br />Lake Forest, CA 92630 rNSORt'"ftC'
<br /> fNS(.'ftfHO
<br />I ~ttE. ..-
<br />
<br />CO\l1:RAGl:.S
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<br />TH~ POLICIES Qf INSURANCE lISTEO BELOW HAVE BE:EN ISSU€I)TO THE lNSVREO NAMeD Aaov!: Fcm THE POlley PERIOD INDlCA1fC:. NOTWITHSTANDiNG
<br />AN)' REQUIREMENT, TERM on CONomo~ OF A.NY CONTRACTOR. OTHIOR OOCUMENTWITH RESPECT TO WJ.lICH THIS CERT1F1CA.TE MboV BE ISSuEll OR.
<br />MAY PERTAIN. THE INSURANCE AFfORDED BYlHE POliCIES DESCRl6ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS Of SuCH
<br />POLIClES "-CGREGA.TE lfUlTS SltOWNMAY HAVE SEtH RtDUCEO ey PAlO ClAIMS
<br />:llf typE OF INSURANCE I'QlltYNUMIIER 'O;f~T:~~" ok~ LlMtfJi
<br />~ERAL.L1A9I\JT'Y 7 SBA LN1493 C~/IS/'OOl 01/lS/200' E.\C1'f OCClJf';RtNCE . 1.000,000
<br /> );: eOMW::FI.CIAt O::UE:RAt U...8lLITV FiRfClAAlAGE(""'1":"'~(.1 . 300 000
<br /> ~ ~ CtAlMS 'AADE 00CClJR Ml;DUP(An,Otl.~on} , 10,000
<br />A PE1l,s0N.u,...>\DV.NJtJ11T , 1,000.00
<br /> O("'fAAl AC~EGAff , 2,~?~
<br /> ~~ACG~r~~~6: Ar:~tlf>t:R PAODucTS . COMPIOP AW . EXClUDE!
<br /> POliCy ] Jt:CT lOC .-.
<br /> ~lOMO"tl.f: I..IAlttUrr COlMllNED SrNQ.E llWI .
<br /> AAYAUm tE"'."">d~lltt 1,000,00
<br /> ~ ALL OwNeo AlJtOS BOOtl Y INJ\J~Y .
<br /> ~ S(,.-m;OlSl(o....uros [PlI/'P9llQ#lI
<br /> .; HfItEOAlHOS e.o(ll!.VINJ{Jf('f
<br /> .
<br /> ~ N~.OWNt:O lI.ulOS \P.'~;~"lj
<br /> PAOPO\lY OAMA"'" .
<br /> \PQlACC,,,,,,..lj
<br /> R":"""'''''''' AlITO OliLY - E.... ACCIOENT .
<br /> AN'(AtJy() on1f:ltt~ EAACC .
<br /> AUTOON>kY 'OC .
<br /> -.
<br /> p~S$lIA8ILlTY EADlO<;CUJ\RE...CE. ,
<br /> OCCUR: 0 CVU-"lS NADI: AGGIl:ECI\T!: .
<br /> .
<br /> l,DfDUC"rlSlC .
<br /> RETENlIcm . .
<br /> l'YOkXEItS COMPENSA"1IOH AHO OS9JSH Ol/10/l001 OJ/I0/z00Z X I iOA';liMJ~S liVe';'
<br /> EMPlOYEAS'UA8lI.ITY fl. E....CHACCIOE~T . l,OOO,OYO
<br />B
<br /> ElOl$I'UlSE ,fA 'E~PlOYU , 1.000.000
<br /> H. OlSEASE, POlICY llMfr , l,OOO,DOI
<br /> l)fHU
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<br />tlESCRIPTlfN O~ OPER.\TlIJNSllOC"f~$f\j'EHll:lESfEllCLU$ION:i _DOED IY ENtlOftr....ENT/S"t:<:lAl PROVISIONS
<br />ity 0 S~nta Ana. its officers, agents, and emp oyees are to be n~med a. additional insured
<br />rith regards to insureds business operations,
<br />pdditional Insured only applies to General Liability policy,
<br />e. [IG) ~ay notice of cancellation for non-payment of premium ~hal ) apply_
<br />CERTIFICATE HOLOER I I AOOITIONAt INSURt.O; INSUlteR t.fnER; CANCELLATION
<br /> ~O\ll.OANY o~ THE A!lOV&. DfSCAl.IIliD PO~!1:'ES BE c.......u::Et.lEO &EFORf THE t::
<br /> Cit~ of Santa Ana fi.J.f'lFtATlQN o...u: THE:REO" tltE 'SSUlNG C::OMPAN\' Will tj.ItC""l11'1 HI "'All
<br /> Water Resource Division -12- O....YS WAITt!!:N; ,"oner: TO nU! CEln1l'ICATE 110l0ER NAMED H) ntElEFT4'
<br /> Public Works Agency
<br /> Attn: Ray Burk . H. 'ill . . . . r
<br /> 2205. Daisy Avenue , 1. 5 !l r.I',IT& liE 1&.., nfP'1ES! /; T ~!,
<br /> Sa.ta Ana, CA 9270J AUTWORQ:!!:O lUP1teseNTAnVE ~,~-
<br /> Debbie Upland22/SA.NOEE
<br /> T N 1 88
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<br />~rvJ
<br />t,1rk!
<br />711,,';'1
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<br />ACQRO 2S.S 17191)
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<br />fQACORD CORPORA 10 9
<br />
<br />APPROVED AS . '0 FORM
<br />
<br />MIchael Vigliot1a
<br />Deputy City Attorney
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