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<br />PROOUCI!R(ii4)939:0800 FAX
<br />al-Surance Associates, Inc.
<br />PO Box 7048
<br />333 City Blvd., West. Ste. 400
<br />Orange, CA 92863-7048
<br />Att": Apri 1 ,Wal ker
<br />'iNSlIREO'"
<br />CalPac, LLC
<br />On-Site Fabricare Service, LLC
<br />7711 Amigos Avenue, Suite B
<br />Downey, CA 90242
<br />
<br />
<br />Ext: 466
<br />
<br />07/07/1999
<br />
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />COMPANIES AFFORDING COVERAGE
<br />
<br />COMPANY ........U.~.i-t'e-d"..S.t.a.t'e.s....F.i..r.e...i~.~-:'-. Co.
<br />A
<br />
<br />COMPANY
<br />B
<br />
<br />North River Ins. Co.
<br />
<br />COMPANY
<br />C
<br />
<br />S ta te ...c.o.iilp.e.~.s'a.t.i..o.n".i~.~.~.~a-~.c.e.. Fun d
<br />
<br />COMPANY
<br />D
<br />
<br />. . ..:.:.:,:.:.:.:.:,::.:.:.:.:.', '.'" , . ......... ..........: '::,:;:::::::::::::::::::}::;:F:::::::.:,:.:...:.:.............:.:~.........'''' .. N :{}::::::::::::::::t::::::::::;(:\/?\(?tit: ::::::::::::::::::::::::::::::::::::::::::::. ..::::::::::::::::::::::::::::::::::(}{::\~::::::::::::::::::,.:.:......' .
<br />.'f~i~i~t62~~tij;y THATTHEPOUcfEifoi"iNSUAANCE listED .~~i.bWHAV~ ~~~Ni~gtEbT6'tHEiNSUREO' NAMEO'ABOVE'FORTHEPOLicy'PERIb!j'"
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />CO
<br />LTR
<br />
<br />TYPE OF INSURANCE
<br />
<br />POLICY NUMBER
<br />
<br />POLICY EFFECTIVE EXPIRATION
<br />DATE (MM.'DDIYY) DATE (MM/DDlYYI
<br />
<br />LIMITS
<br />
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL L1ABIUTY :
<br />CLAIMS MADE X OCCUR
<br />A !060030967
<br />OWNER'S & CONTRACTOR'S PROT :
<br />
<br />B
<br />
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />X HIRED AUTOS
<br />X NON-OWNED AUTOS
<br />
<br />1336252968
<br />
<br />
<br /> GENERAl AGGREGATE $ 2,000,000
<br /> PRODUCTS - COMP/OP AGG $ .2...0.0.0.,.000
<br /> PERSONAL & ADV INJURY $ 1,000,000
<br />10/01/1998 10/01/1999
<br /> EACH OCCURRENCE $ ....... ..~, ~..q .~. ~..~ .~q.~..
<br /> FIRE DAMAGE (Anyone fire) S 100,000
<br /> MED EXP (Anyone person) $ 5,000
<br /> COMBINED SINGLE LIMIT S
<br /> 1
<br /> BODILY INJURY S
<br /> (Per person)
<br />10/01/1998 10/01/1999
<br /> BODILY INJURY S
<br /> (Per accident)
<br /> PROPERTY DAMAGE S
<br /> $
<br />
<br />
<br />B
<br />
<br />THE PROPRIETORJ
<br />PARTNERs/EXECUTIVE
<br />OFFICERS ARE:
<br />OTHER
<br />
<br />INCL
<br />EXCL
<br />
<br />046990006606
<br />
<br />01/01/1999
<br />
<br />01/01/2000
<br />
<br />
<br />EL DISEASE. POLlCY LIMIT
<br />EL DISEASE. EA EMPLOYEE
<br />
<br />GARAGE LIABILITY
<br />ANY AUTO
<br />
<br />EXCESS LIABILITY
<br />UMBRELLA FORM
<br />OTHER THAN UMBRELLA FORM
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />
<br />DESCRIPTION OF OPERAT10NSlLOCATIONSNEHICLESfSPECIAL ITEMS
<br />HE CITY OF SANTA ANA, ITS OFFICERS, AGENTS & EMPLOYEES ARE NAMED AS
<br />ODITIONAL INSURED PER FORM FM101,1,1459 ATTACHED.
<br />10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM
<br />
<br />
<br />AIl0RD;.211i!l.{119'!..... ..
<br />. ,...., ,--,-..
<br />(::::,;:.::.,,::.:..:::<.::::.::.:.:.:.:.::::::..../:...;.:.:<.:.::::~.):::::::::::::::
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<br />
<br />--.--.............."........
<br />...........................
<br />......_....._..-.._..-.....-.w.-...-.....
<br />...................
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL~~ MAIL
<br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />~\(I)(Il(\Jl.J/_MHIll(_~M~~l!m!"~~X
<br />~~~MX~~!{l': !\1l(~,*"WWM;xxxxxxX
<br />AUTHORIZED REPRESENTATIVE ~
<br />
<br />... .. . .~.r'i.~..;.......\.j;;;...~ ................I......III~;~___T!R!!l!~..
<br />
<br />CITY OF SANTA ANA
<br />ATTN: DORIS TURLEY
<br />FAX #714/647-6956
<br />PO BOX 1988 M-25
<br />SANTA ANA, CA 92702
<br />
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