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<br />From ALison Vent Tc:\,Ihndy <br /> <br />DatE 1/2/02 Time: 10:3314 AM <br /> <br />Page 2 oiti <br /> <br />AkQRD. CERTIFICATE OF LIABILITY INSURANC~o~~~ ~ DATE (MM1DDJYY) <br />l2/3l/0l <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />G. S. Levine Insurance ONL V AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Services, :IDe. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3371 Carmel Mountain Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />San Diego CA 92l2l INSURERS AFFORDING COVERAGE <br />Phone: 858-48l-8692 <br />INSUR60 iNSURER A American MOtorists 7nsuraDce <br /> INSURERS <br /> W. Koo ~foeiates, Ine iNSURERC <br /> 600 ~e C t! ParkWay, ;3l0 iNSJRER:J <br /> Orange CA 9 868 <br /> , NSUREi< E <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOABOVE FOR THe: POLICY PERIOD INDICATED. NOTWITHSTMlDING <br />ANY REQUIREMENT, TERM OR CONDITION OF MNCONTRACT OR OTHER DOCUMENT WITH RESPECT TO W'HICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T::l ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CWMS. <br />r.,:1 TYPE OF NSURANCE POLICY NUMBER bii~~M~b~1i '[f'AL;!i~~~N , liMITS <br />~ERAL llABIUTY i E.A.CH OCCUPRENCE Il,OOO,OOO <br />A~ D~ERCIA.. GEf'ERAL. LIJIBILlTY 7RS66343402 l2/21/0l 12/21/02 FIRE DAI'I'AGE (Any 01e fire) IlOD,OOO <br /> - CLAIMS t-IADE ~ OCCJR MEJ EXP (Mj one pel'9:ln) IlO,OOO <br /> - PERSO~ & /JDV IN~LRY Il,OOO,OOO <br /> - GENFRA_ AC,GREC-ATE $ 2:,000,000 <br /> GEr-. t .o\GGREGA"1: LIMIT ApollES PER PROCI.JCTS . COVPlGP AGG 12,000,000 <br /> I ;>OLlCl' n ~~8i n LOC <br /> AUTOMOBILE LIABILITY COMBINED Slt,GlE L;~I!IT <br /> - ! $1,000,000 <br />A ANYAJ.JTO 7RS66343402 12/21/0l 12/21/02 (E~ f1~cider1) <br /> .-- <br /> - ALL OWNED AJTOS BOCIL Y INJURY <br /> ("'arparson) I <br /> - SUEDULED AUTOS <br />~ HIREDAJTOS BCDIL Y INJURY <br /> I <br /> .!. NON-OW\IED AUTOS APPROVED AS TO F )RM (pEir ~cc;dent) <br /> - ~\... I~ PROA;:h'I" lJAMAGE I <br /> (per~ccid~) <br /> GAftAQ! LIABIL.1TY CR TIN" LitE SHAW Alre ON... Y - E.A AC:IDENT I <br /> RA\lYAlJO Deputy City Attorney! OTHER THAN EAACC I <br /> AUTOON...Y AGG I <br /> , <br /> ElCCESS LIABILITY FACH OCCLJi'fPF.NCF $ 4,000,000 <br />A r:r::co...f< 0 CLA'MSMAOE 1RS66343402 l2/21/Dl 12/21/02 AGGR:::GATE 1$4,000,000 <br /> ,I <br />~ DEDJCT BLE I <br /> 'X RETENTION 10 I <br /> WORKERS COMPENSATlON AND I TJRy' L1~Yis I IV ER <br />A EMPLOYERS' LIABIlITY 1an0516104 Og/01/0l Og/01/02 E.L. ~H ACCIDENT IlOOOOOO <br /> E l. DISEASE - Ell EMPLO"'EE IlOOOOOO <br /> EL. DISEASE - POLICY LIMIT IlOOOOOO <br /> OTHER <br />DESCRIPTION OF OPERATIONSllOCA1l0N8JVEHIClESJEXClUS10NS ADDED BY EtoI>ORSEMENT1SF'ECIAL PROVISIONS <br />Re: south Station Reservoir Project - Job No: 55-00l <br />city o~ Santa ADa, City o~ Orange, its officers, agents and employees are <br />Damed as Additiona1 Insured per the attached BP8662 endorsement. *lO day <br />notice of cancellation applies for non-payment of prem1wn. xx <br />CERTIFICATE HOLDER N I ADDITIONAL INSUREO; INSURER LETTER: CANCELLATION <br /> CU'YOSl SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL.lEO BEFORE THE EXPlRATlON <br /> city o~ santa Ana DATE lHEREOF, THE ISSUING INSURER WILL _..~_.. .~- -~ MAlL ....3O...t DAYS 'WRITTEN <br /> Public Works Aqency NOTlCE TO TIE CERTlFICAlE HOLOER NAMEO TO THE lEFl, I VI" r II.. FlIrt 111111 L.IlsL.. <br /> Steve Horra1 Pit ...---- ..- --. .-.- ...-.- ir .-- f"-Iir:l,R'" <br /> 220 Daisy Avenue RB'"f\I!ll!!lfF. "R.ll!. <br /> Santa ADa CA 92103 ~ <br /> , <br /> <br />ACORD 25-8 (1/97) <br /> <br />~ <br /> <br />~ACORD CORPORATION 1988 <br />