|
<br />-,
<br />
<br />~c:.... ...., IU.L .1."........1""' r-",""""'l"'~ .......C~...
<br />
<br />.....................fI,
<br />
<br />. . .
<br />
<br />....-
<br />
<br />~C.IJoZIO' 11i:1IA~ FROIi-THI"<U" r SMITH ~ND~SSOCIATES
<br />
<br />I
<br />
<br />ACORD. li~H Ilrv,'"' I t; + 4141&1111 T.565 P.OOI/OOI F.m
<br />vr L''"'U.....,. I' ...--- \;. .J.--r^I.,;'&',r-,)
<br /> - --..... --
<br />PfKlOUC[A TH'" '~ERTIF1CATE IS Il!!UEO AS A MAnEII OF INFORMAnoN
<br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIACATE
<br />THADDEUS W. iJM%TK " ,p.S!lOC. HOLtER. THIS C~RTIACATE DOn NOT AMEND, EXTEND OR
<br />20151 s.W. IHI\C11 ST. SUITE 250 ALTE~ TH~ COVERAGE AFFOROEO BY THE POlICIES BELOW.
<br />NEWPOJlT .SAOt CA _2860 J '721 INSURERS AFfORDING COVERAGE
<br />Phone:",-622-20'5 F,,,..9U..&11i-Dl68
<br />LN$UAlEO -
<br /> INSUPl!A-= 'l'RAVELERS PROPEl<TY U CASUALTY
<br /> P&Cil!ic C:i Bottling COX>> ~'''I~
<br /> Michl.al ~ ns t1Suft!Rr;:
<br /> 18D1 p.r court place 'ZOO lNSURi" 0:
<br /> Santa AlIa CA 92'701
<br /> ,- I.'olSVR'A !!
<br />
<br />COVERAGES
<br />
<br />lH1i POUCliS 01' 1N~'AN\lCf ,,1ST!;) &ELOW !'lAVi ~!CllOl:l!\lD TO THE INsu"EO!ll~~O AgQ\l!,DA tHt: ~1.1C'" 1'~100 -.oICAT;O. '-IO'l'INiTH.$TA...cINCo
<br />M:Y RiCUIAEIol(t(T. r!RM 0<1 CCM)ITION OF ANY CO\lTAACT OR OllilA COCUl.leNT ....m'ii ~.s"iCT rei wl-l'lCt-iTtfI$ C;"TJfI!ICA~ MAt K tS5uEtl CIA
<br />......... 'VlI1<.l. 110E 1N!:Ullb\.\ICIi: ~i'fQI\DED.y lHE la(IUOfS DiSCl'lllltO HERe'1N 1$ SUILI!CTTO AU. T"E TlilWS. i](CLuSlOsS ANOCONOlTtOkS Oil' .stJCH
<br />POllC1f~. ...cG~EaATi\.1Mln SIofOWN ......, H"ve-IlE[:Poi RaQUCEl) I\' PAlO C\,AIYS,
<br />m T'fll'~Of' LIl,\nI:ANCl!. - ~1C""'1AfUJt
<br />,,!!NOll lJA'Iln"
<br />A ..! ~\!Mfl'QALCe~I.LtA8lllT1' Q~O-2985W011-~IL-D1
<br />_ U c~lUSu~1 [j] CCOJf\
<br />
<br />~~
<br />
<br />DnE Mt.'IDDIY'l' "'I
<br />llACIt OCCURRENCi
<br />10/25/02 ! ,!AL!J)A,...ol,Ql!tJY!,.....III..
<br />I.4EOIiIt"''''''I'MlpMgt\)
<br />P!"I!Oro/IoL..,.OVINJU""
<br />,'~AGGAEOA'ni.
<br />
<br />",..n
<br />'1,000.000
<br />150,000
<br />S 5.000
<br />11,000,000
<br />12...000,DOO
<br />"l\OOUCTS.CdMPIO"~ 12,000,000
<br />
<br />10/25/01
<br />
<br />f-
<br />~L AQGA~!,LUdiT APPlES p~'
<br />I IpOl.CY! Ij~~T nLOC
<br />'~TOJ>t08ILI!U.U<<JTY
<br />A _ A!'tY"U'tO
<br />~ AL()N!lifD/.uTOS
<br />~ SCrEQuLED ,\UTOS
<br />~ H.fI.r!O AUTOl
<br />~ NOl<o.()WPlriD AUTOS
<br />
<br />COMll~O s,:ISCU: \.lUll'
<br />1!lllIcl'_1
<br />
<br />:J:L.ooo,OOO
<br />
<br />J.O/2.5/0.2. aOOJl"YlNJ\Jllv
<br />(Pll....'''^'
<br />
<br />10/2!t/O~
<br />
<br />B1C-2'85W017-~1L-Dl
<br />
<br />.
<br />
<br />BOOll\'lI'UUftT
<br />rp..."c,....)
<br />
<br />.
<br />
<br />~,.~~~~,....&G! ,
<br />
<br />h:CElIAIllrr.
<br />HA.....,"U'O
<br />
<br />AUTO ONl'l'. t.a. &CeDENT ~
<br />EAICC .
<br />"'" .
<br />
<br />0'",," THAN
<br />",IITO~LV'.
<br />
<br />f....."'H Oc[;uAA'l'fCe
<br />ACOAEGATE'
<br />
<br />.
<br />.
<br />.
<br />.
<br />.
<br />
<br />DCUSLlAltl,lT';
<br />::~:rCCC\JA =:J CLNM$. wAO€
<br />
<br />-, D(tVCTt&.r!
<br />--1 AEl'Ep,tTION t
<br />WOAllf'" COMP1H8"TlQN ANO
<br />IMPLOY(M"Ll.lelllTY
<br />
<br />TOA" LI",.rsl I....;..
<br />ll., IiACI1 ACCIOfH'l'
<br />
<br />I
<br />~ I .
<br />
<br />lil$CRlPJIlJH O,"OI'E""TIONS/'I.QC.TICNSo"eHtCL~:Jl'1 JC:L~O"" ADDlED IV ~OOAUMD4TJS'Er:1AL fROVtSfONS
<br />Certificato Holder is inclut'.d AB additional in.Q.red as ra!&pects the
<br />
<br />in.u:red'. pl'04ucta. (:b-ottle<1 wat.er) . 10 Oays not!.!;. af e&Zlcellation
<br />
<br />non pa1JNmt of prel'fti 'IlII'..
<br />
<br />I! L.tllS.....,t.'.. Eu~LO'tliE ,
<br />
<br />1!.L.OI$l>AS(.POLICYI,IMlT J
<br />
<br />onE~
<br />
<br />
<br />.
<br />
<br />if for
<br />
<br />CERTIFICA IE HOlDEJI
<br />
<br />ty I AI~1HSURED:IN$UAEFlt.mc";.........
<br />enY OF
<br />
<br />
<br />CANCI;LlATION
<br />,"DU!;) ","'1'011 TttC "lave "ISCAlII!D 1I0UCIf:S.' C'ANCE.LUO .UORa THI! _Iftl.
<br />bAn. T"'I:"'''OI'. T...rssUINCINS.UAEA WILL ~l1-1L ..3JL.. 0""5 WAITT
<br />N01!Cl TO "101& C~.IIN')CATI! hOLDER KA."'IC' Ta THe. LEFT.
<br />
<br />C1~y of santa Ana
<br />Attc: Them Cougbrm~
<br />Water Manager
<br />220-A South DaLey A'\"8DUe
<br />santa Ana CA .~703
<br />
<br />ACORO 25.S (7/97)
<br />
<br />
<br />~.
<br />III ACORD CORPORATION '988
<br />
|