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<br />~ NCI: CSR MJ <br />, 'IroOWA-1 11/14/02 <br />THIS CERTIFICA IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERJIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />~ <br /> <br />rACORD. <br /> <br />OF LIABILITY INS' <br /> <br />CERTIFI <br /> <br />'\. -': <br /> <br />PRODUCER <br />G. S. Levine Insurance <br />Services, Inc. <br />3377 Carmel Mountain Road <br />San Diego CA 92121 <br />Phone: 858-481-8692 <br />INSURED <br /> <br />'" 7/ <br />N /~\ .-\V\ <br />~ <br /> <br />DATE (MMfOOrrYJ <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />American Motorists rnsurance <br /> <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1~t'G TYPE OF INSURANCE POLICY NUMBER DATE"rMMID~ DATE MMIDONv\' LIMITS <br /> GENERAL I.IABILlTY EACH OCCURRENCE $ 1,000,000 <br /> r- 12/21/02 12/21/03 <br />A X COMMERCIAL GENERAL LIABILITY 7RS66343403 FIRE DAMAGE (Anyone fire) $100,000 <br /> I CLAIMS MACE [i] OCCUR MED EXP (Anyone person) $ 10,000 <br /> PERSONAL & ADV INJURY $ 1,000,000 <br /> r- <br /> f- GENERAL AGGREGATE $ 2,000,000 <br /> n'LAGG~En ~~~ APnStPER: PRODUCTS - COMPIOP AGG $ 2,000,000 <br /> POLICY JECT LOC <br /> ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br />A ANY AUTO 7RS66343403 12/21/02 12/21/03 (Ea accidoot) <br />r- <br /> f- ALL OWNED AUTOS BODILY INJURY <br /> {Per person) $ <br /> SCHEDULED AUTOS <br /> r- <br /> ~ HIRED AUTOS APPROVED AS "0 FORlVJ BODILY INJURY <br /> {Per accident} $ <br /> ~ NON-QWNED AUTOS v/W,? d, <br /> - PROPERTY DAMAGE $ <br /> /,--;t/ p" (Peraccidenl) <br /> GARAGE LIABILITY LaUra :::,'1."', ('V AUTO ONLY. EA ACCIDENT $ <br /> ~ ANY AUTO Lleputy City AU,Jfll":) OTHER THAN EAACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS LIABILITY EACH OCCURRENCE $4,000,000 <br />A ~ OCCUR D CLAIMS MADE 7RS66343403 12/21/02 12/21/03 AGGREGATE $4,000,000 <br /> $ <br /> ~ DEDUCTIBLE $ <br /> X RETENTION $ 0 $ <br /> WORKERS COMPENSATION AND X I TORYUM,,:sl IUER- <br />A EMPLOYERS' LIABILITY 7CW30576705 09/01/02 09/01/03 E.L EACH ACCIDENT $ 1000000 <br /> E.L. DISEASE. EA EMPLOYE $1000000 <br /> .. <br /> E.L. DISEASE - POLICY LIMIT $ 1000000 <br /> OTHER <br /> - <br />DESCRIPTION OF OPERA TIONSILOCATlONSNEH1CLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />Re: 1st, 5th Street & McFaden Avenue Bridge <br />City of Santa Ana, Public Works and City of Orange is named as Additional <br />Insured per the attaohed endorsement. (See Images 1-2-02 for Special Endt) <br />*10 day notice of cancellation applies for non-payment of premium. xx <br />CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION <br /> CITYOSA SHOULD ANY OF THE ABOVE DESCRlBED POLICIES BE CANCELLED BEFORE THE EXPIRA TIO <br /> City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL 'MAIL -3..0..!.. DAYS WRITTEN <br /> Public Works NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> Attn: Joe Parco . -~ <br /> 20 Civic Center Plaza POB 1988 <br /> Santa Ana CA 92702 -- <br /> AU'}1';IZED REPRES~ n <br /> ~ d - <br /> I ~ <br /> I D CORPORATION 1988 <br /> <br />INSURER A:. <br />INSURER B: <br />INSURER c: <br />INSURER 0: <br />INSURER E: <br /> <br />w. Koo As~ociates, rnc <br />600 The C1ty ParkWay, #310 <br />Orange CA 92868 <br /> <br /> <br />COVERAGES <br /> <br />ACORD 25-5 (7/97) <br /> <br />@ACOR <br />