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<br />F~or; Allison Kent To: Mlrdy <br /> <br />Date: 1/2/:)2 Time 10:3314 AM <br /> <br />Page 3 of 5 <br /> <br />~CQliD. CERTIFICATE OF LIABILITY INSURANC~~!.Cl ~ DAlE (MMJODIVY) <br />12/31/01 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />G. S. Levine Insu%&nce ONL V ANO CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Servicea, :Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3377 C8%mel Mountain !load ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />San Dieqo CA 92121 INSURERS AFFORDING COVERAGE <br />Phone: 858-481-8S92 <br />INeURED iNS~ERA American WDtorists ~nsuraDce <br /> :NS~ER B <br /> W. Koo Asfociates, Inc ;NSURER C <br /> 600 The C t! Pa%kWay, ;310 iM:iURER D <br /> O%anqe CA 9 868 <br /> INSURERE <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />_ REQUIREMENT, TERM OR CONOITION OF _CONTRACT OR OTfER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, TWE INSUR.A.NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOV\t.lMAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />"'R TYPE OF INSURANCE POLICY NUMBER s~*crM~b~& PooA"Ii':~~,JJ.?N UMlT' <br />LlR <br /> ~NBW. LJABIUTY EACH OCCURRENCE $1,000,000 <br />A ~ 3MERClAL GEtERA... L1PBILlTY 7RS6S343402 12/21/01 12/21/02 FIRE DAMAGE (Any Q:le fire) $100,000 <br /> f--. :::LA;MS MADE 00 OCCUR MED EXP (~one person) $10,000 <br /> PEROONAL 8. IJ.[)V INJLRY $1,000,000 <br /> GENERALAr~REGATE $ 2 ,000,000 <br /> h'~ A~REn L~~~~.Pn ~ER PRODUCTS - COMP/OP ASG $ 2,000,000 <br /> POLICY JECl LO:: <br /> ~TOMOBlLE LIABIUTY COMBINEC SINGLE LiM T $1,000,000 <br />Af- ANY AUTO 7RS66343402 12/21/01 12/21/02 (E!lIl.;cide7:) <br /> C- ALL OWNED AUTOS BOOkY INJURY <br /> , <br /> L- SOECUED I\UTJ$ (Per ~ers::Jr) <br /> I~ HREJ AUTOS A VED 14 0 FORM BODL Y INJURY <br /> $ <br /> ~ NON-OVo/J\ED ..\ljTOS 7\. I.> (Peraccldenl) <br /> CF.I ;TINE LEE SHAW PROH::,'HY UAMAGE , <br /> I:Peraccldenl) <br /> ROE LlABlLrY Deputy l:lty At orney AlYO ON... y. Ell. ACCIct"NT , <br /> AN'{/OJJTO OTHER THAN EA AC: 1 <br /> . AlJTQON...Y AGG 1 <br /> ElCCE99L1ULLITV EACH OCCU~PENC:::: $ 4,000,000 <br />A :::J CCaR D CLAIMSMflDE 7RS66343402 12/21/01 12/21/02 AGGREGATE 14,000,000 <br /> ! 1 <br /> 8 ~ECi...CTIBLE ! . <br /> , <br /> X RETE~'JTICN $ 0 : . <br /> WORKERS COMPENSAT10N AND I I ro~$~~~!rs I uE~ <br />A EMPLO'1'ERS' LIMLITY 7CW30576704 09/01/011 09/01/02 ' . 1000000 <br /> EL. EA':H ACCIDEN"' <br /> EL.DISEASE-EAEttP_OYEE $lDOOOOO <br /> I <br /> I EL DISEA.SE POLICY LIMIT $ 1000000 <br /> OT><ER I <br /> . <br /> , <br /> I <br />DESCRIPTION OF OPERATIONSILOCA11ONSNEHIClESJEXCLUSICNS ADDEO BY Ett)ORSEMENT1SPECIAL PROVISIONS <br />Re: 1st, 5th St%eet & IfCFaden Avenue B%idqe <br />city of Santa Ana, Public Wo%ks and city of o%anqe is named as Additional <br />~nsured. per the attached endorsement. (See :Imaqes 1-2-02 for Special Endt) <br />*10 day notice of cancellation applies fo% non-palllll"nt of P%emiUIII. Xl< <br />CERTIFICATE HOLDER IN I ACDITlDNAL INSURED; INSURER L.ETTER: CANCELLATION <br /> CITYOBA SHOULD ANY OF "THE ABOVE DESCRIBED POliCIES BE CAHCB..LEO BEFORE TlotE EXPIRAT10N <br /> city o~ Santa Ana OATE THEREOF, Tl-lE ISSUING INSURER WILL ._~~- uAIL ...3O.!-OAYS'NR/TTEN <br /> Pul:>lic wo%ks NonCE TO TtE CERT1FICAlE HOL.DER NAMED TO THE LEFT, ~,-~... "1&,. ii -- .'lIbL <br /> Attn: Joe Parco .-. ~-- ..- ~-~~.. .- . ~.. ~..~_.,' ~, .-.. ...___. '._n._._., In <br /> 101 west FOu%th st. , 3rd 1'100r <br /> santa Ana CA 92701 I1I!rllJ!!ll!!l.R\M",.I. <br /> ~ <br /> <br />ACORD 25-8 (7/97) <br /> <br />~ <br /> <br />~ACORD CORPORATION 1988 <br />