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. ACORD. CERTIFIGA TE OF LIABILITY INSURANCfiodii~~MJ I DATE (MMIDDfYYl 08/2~/02 PRODUCER AJ-ZaJI- LU6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION G. S. Levine Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services, "Inc. 11 -ZtJCO - Nq HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3377 Carmel Mountain Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Diego CA 92~2~ INSURERS AFFORDING COVERAGE Phone:858-48~-8692 INSURED INSURER A: American Motorists Insurance INSURER B: w. Koo Associates, Inc. INSURER c: 600 The Cit~ Parkway, #3~0 INSURER 0: Orange CA 9 868 , INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'rfR' TYPE OF INSURANCE POLICY NUMBER DATE MMIDD rc DATE MMIDD LIMITS ~NERAL LIABILITY EACH OCCURRENCE $ ~,OOO,OOO A X COMMERCIAL GENERAL LIABILITY 7RS66343402 ~2/21/0~ ~2/2~/02 FIRE DAMAGE (Anyone fire) $ ~OO,OOO I CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $~O,OOO - PERSONAL & ADV INJURY $ ~,OOO,OOO GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 IPOLICyn~~8i un-LOC AUTOMOBILE L1ABIUTY COMBINED SINGLE LIMIT - $ ~,OOO,OOO A ANY AUTO 7RS66343402 ~2/2~/0~ ~2/2~/02 (Eaaccidenl) - - ALL OWNED AUTOS BODILY INJURY AS TO PC $ SCHEDULED AUTOS APPROVED RM (Per person) - ...!. HIRED AUTOS BODILY INJURY $ ...!. NON-OWNED AUTOS ':I1L" / (Pereccldenl) - PROPERTY DAMAGE $ f '<'ufll Sheedy/ (Per accident) ~RAGE LIABIUTY Deputy City ^ torncy AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $4,000,000 A ~-OCCUR D CLAIMS MADE 7RS66343402 ~2/21/0~ ~2/2~/02 AGGREGATE $4,000,000 $ ~ DEDUCTIBLE $ X RETENTION $ 0 $ WORKERS COMPENSATION AND I f6'R~',')~YTsI IU~~- A EMPLOYERS' LIABILITY 7CW30576705 09/0~/02 09/0~/03 E.L. EACH ACCIDENT $ ~OOOOOO E.L. DISEASE - EA EMPLOY~~ $ ~OOOOOO --- ------- ----_._._~-- E.L. DISEASE - POLICY LIMIT $ ~OOOOOO OTHER DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: 1st, 5th Street & McFaden Avenue Bridge City of Santa Ana, Public Works and City of Orange is named as Additiona~ Insured per the attached endorsement. (See Images ~-2-02 for Special Endt) .~o day notice of cance~lation applies for non-payment of premium. xx CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LEITER: CANCELLATION CITYOSA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL MAIL -3...D...!.. DAYS WRITTEN Pub~ic Works NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: Joe Parco 20 Civic Center P~aza POB ~988 Santa Ana CA 92702 , AU'!f;IZE.O REPRES~ All. n , @ACORDCORPORATION 1988 ACORD 25-5 (7/97)