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<br />j ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNY)
<br /> 07/10/2002
<br />PRODUCER (949)263-0606 FAX (949)263-0906 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Complete Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />Cal i fornia oor 10437762 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br /> 1500 Qua i 1 St. , Suite 410
<br />Newport Beach, CA 92660 INSURERS AFFORDING COVERAGE
<br />INSURED Albert Grover & Associates, rne. INSURER A: American Manufacturers Mutual
<br /> 211 E. Imperial Hwy. , Suite 208 OJ-~ INSURER B: American Motorists Ins. Co. .
<br /> Fullerton, CA 92835 A,;,o03t" O'l~ INSURER C (c/o Kemper OSA) I
<br /> INSURER O' I
<br /> , ~ I ,:JOO?'''' INSURER E
<br />COVERAGES I
<br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING i
<br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WlTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOAll THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH i
<br /> POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I
<br />INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE Pg~tpEY,~~bRtmN LIMITS I
<br />lTR DATE MMIOOIYY
<br /> ~NeRAL LIABILITY RE80853900 07/01/2002 07/01/2003 EACH OCCURRENCE , l,OOO,OOO[
<br /> X COMMERCIJlL GENERAL LIABILITY FI"E DAMAGE iAny one fire) , 500,000'
<br /> I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) , 10,000
<br />A f- PERSONAl.. & ADV INJURY , 1,000,0001
<br /> '- GENERAL AGGREGATE , 2,000,000
<br /> n'L AGG:EnE LIMIT APAS PER PRODUCTS. COMP/OP AGG , 2,000,000:
<br /> PRO- l
<br /> POLICY JECT lOC
<br /> ~TOMOBILE LIABILITY RE80853900 07/01/2002 07/01/2003 COMBINED SINGLE LIMIT
<br /> (Eaacc,denl) ,
<br /> '- ANY AUTO 1,000,000
<br /> '- ALL OINNED AUTOS BODILY INJURY
<br /> (Per person) ,
<br /> SCHEDULED AUTOS
<br />A :--
<br /> 2- HIRED AUTOS BODILY INJURY
<br /> (Pereccidenll ,
<br /> !...- NON-OWNED AUTOS
<br /> PROPERTY DAMAGE ,
<br /> IPeraccidenlj
<br /> ==i~GE LIABILITY AUTO ONLY - EA ACCIDENT ,
<br /> ANY AUTO OTHER THAN EAACC ,
<br /> AUTO DNl Y AGG ,
<br /> EXCESS LIABILITY RE80&S3900 07/01/2002 07/01/2003 EACH OCCURRENCE , 2,000,000
<br /> fj:CCUR D CLAIMS MADE AGGREGATE , 2,000,000
<br />A ,
<br /> =i ~EDUCTlBlE ,
<br /> RETENTION , ,
<br /> WORKE.RS COMPENSATION AND BG08850202 07/01/2002 07/01/2003 X I r"~~-L~I~S I IOJ~-
<br /> EMPLOYERS' LIABILITY El. EACH ACCIDENT $ 1,000,000
<br />B 1,000,000
<br /> 1'0 FORM E,l. DISEASE - EA EMPLOYE ,
<br /> APPROVED AS , El. DISEASE - POLICY LIMIT , 1,000,000
<br /> OTHER ~~ i4' 10 day notice appl i es to
<br /> CRIS E LEE SHAW non-payment and/or
<br /> ~,.. non-reporting of payroll
<br />l-D_ESCRIPTlON OF OPERATlONSILOCATlONSNEHICLESIEXCLUSIONS AD'CEVBY ~NDORSEMENTfSPECIAL PROVISIONS but only if required by written
<br />ertificate holder is additional insured as respects general liability
<br />ontract with the named insured prior to an occurence and a, per coverage form BP7434 . Coverage subject
<br />0 all policy terms and conditions.
<br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER lETTER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE i
<br /> City of Santa Ana, its officers, employees, & EXPIRATION. D..a!E THEREOF, THE ISSUING COMPANY WILL lrweX~ MAil
<br /> representatives .2.L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br /> Publ i c Works Dept. .~II(a::~J()liX1(~tlJ.).:jfll!l:OSElllC))II~~~)(.)JXX
<br /> Attn: Dowling Tsai, Trfc Eng
<br /> Ma i1 Station 43, P.O. Box 198& ~k~~~X~X~OCS~~X~<<~~A~~~XXXXXXX
<br /> Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATIVE ~c;7:~
<br /> Al i cia Il1ram, AAI*/MICHMA
<br />
<br />ACORD 25.5 (7197)
<br />
<br />@ACORD CORPORA TIDN 1988
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