|
<br />MOV 05 2000 12:32AM
<br />
<br />HP LASERJET 3200
<br />
<br />p.2
<br />
<br />'l'or
<br />
<br />,
<br />,
<br />
<br />If-U()2 -IOS-- .;rl
<br />ACORQ. CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />"'"'
<br />
<br />...;
<br />
<br />P~C'R-Y800)843-5054
<br />i arr Cut I sr- & Assoc i ;JLes
<br />329 W~sL State Street
<br />RedJa1ds. '-A 9237~
<br />ler i \1~cOO\be
<br />~llr i ~~cr~> Church-:Jnc.
<br />lIinJJ re Street L2arn niJ
<br />5001 Newport CD~st Dr,
<br />In'j'1L:, CA 92f5])
<br />
<br />FAX (909)30/-1245
<br />
<br />OhYt:(_IUDIrf)
<br />01 f08/2rXJ2
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INfORMATION
<br />ONLY ,l\ND CONFERS NO RJGtfrs UPON THE CERnFICA'lE
<br />HOLDER. T./fIS CERTJf(CATE DOES NOT AMEND. eXTEND OR
<br />ALTER THE COYERAGE AFr=ORDED BY THE POLICIES BELO\N.
<br />
<br />Cent.~;:'.
<br />
<br />'HSlJRERS AFFORDING COVERA.GE
<br />INSUR.;~~-':-- GLljdrJOne InSut'3nce
<br />
<br />ji't..<;1l"~f.!n-
<br />.'.------
<br />
<br />COV~RAGES
<br />
<br />ItoSUH.+;RC:
<br />If\1SIJRERD;
<br />INSUIlEQ::
<br />
<br />I tiLPOi.ICIES OF lt~SURANCE'_ LlSTED BELOW I,AVE B-EEH ISSUED TO -HI-. INSURl;;U NAMEDABOlJl-'- FOR nil:. POLICY PERIOD INO!G/,TED. NOrwnH:)T,I,NDING
<br />~y r;:E:QUIKt:Mem, TER~ DR. C;JNOn~l.JN OF ANI( CONTRAC I' OR O1HER DOCUMENT WIT1! RESPFCT TO WHICH THISCERT:'R:::A.TE MAY flJ' :SSUEO OR
<br />MAYPE.~TA.I~, THE INSLJHAr-.cEAf-I-Ol~DED BY ll1E POLlCiE.fi nESCRISED HbHi:;llIIIS SUBJ"=:Cl TOAU. 1HETER\fS. FXCllfSION.st.NDC~JlIlONSOFSUCfl
<br />POI...ClES. ,rr.,GGREGI\TF I.lMllS SHOWNMi1.Y HA.ViE ElEE:N REDUCFn (!I'fPAID Cl AIMS.
<br />IiNsR ".._....._--~~~~~r-o- ~ Ija..rcVEFFEC'iWE POIIC:~iJf.,~~~Nf-' ._~____
<br />L.m POde'\' NVM8ER _.. __Dl'H' fWIIIDDN'O_., LMm; _ _
<br />~r~IfDUII.lli.8Ii..ITY 1;"69-028 06/01/2002 06/01/20031 FJ\CHDCGUI1REN.;;E . ~_" .OOO,QQ;
<br />"~ .C~I4ERCI~GE~RALLlI\flIl1T'" 11'IREDA~~(An~()r'"~.Yf~L~ 1 ,aoo,oce
<br />_~:J ClAllIS,","-LlC 0 O::CUR "'[0 '.XP{~lC1I-"'''''''~~ ~ _~qf)~
<br />1\ I PERSONAL & .I'DV :."JURY$ 1 ,C~
<br />X Extcn5ion:,; - GIo~~~~^GG~;Z-- -~OOO,~
<br />~l'~ N3GR~~ ~.~~ AP!'~~l~' fH' PRODUCTS. !;;CNf't(W AGoG t ..____3 ,'(J"OO ~
<br />' 1 "'OllCY I I JEeT r I Lee _.___
<br />
<br />/llJTOMOElllE llAIlIU7Y
<br />X AAYWTO
<br />.-
<br />ALL ONNI-'O JIJJTOS
<br />- S::HElXJlEDAVTQS
<br />A --
<br />HI~=[}Al.iTDS
<br />
<br />1103490
<br />
<br />06/01/2002
<br />
<br />00/0112003
<br />
<br />COMflJI\lEtl SI~Clf I,IMII
<br />rE~ o'E.till",~~)
<br />
<br />-'--- 1 . OOQ, QQ\:
<br />,
<br />
<br />NDl\l.owNl:DAiIT(I~
<br />
<br />BOmL Y INJUR'l'
<br />(~pa"..,,,)
<br />c--
<br />fl.COIlYIN.JJRY
<br />(P~r tl"ddC1l'IJ
<br />-..-.--
<br />
<br />.
<br />
<br />r-
<br />f-
<br />
<br />,
<br />
<br />IJRf.>>'FR.TYOIIJ/i\.GE
<br />(P'J2, ..~,iUu"l)
<br />
<br />GAlM,m: UAellln'
<br />'jA,.j'l'!'Lrl,)
<br />
<br />Alnflc....LY.r/l^~~!~fJ1 $_,. ,,_
<br />01l-t!;'Rl"lffl _~~~ _"_<
<br />ItlJTODNI y~ A.U" S
<br />
<br />EXC~S ,-1Al!ItLrY
<br />D (1(:(IiR r-<<l C:LArMs MAI,F
<br />
<br />~
<br />G-EJU,.,.JrRLE
<br />AETEIHlON $
<br />WORKERS COM'"ENSA~I[)fo III<<)
<br />EI.IF'1..O'l'!.1tS'UIlDlLJTl'
<br />
<br />LACI!:;,CWRI'lEIliCE:
<br />. AGGFlEGArt-'
<br />
<br />-
<br />
<br />---.--..
<br />
<br />,
<br />,
<br />.
<br />,
<br />,
<br />
<br />--
<br />
<br />Cntc:/I .
<br />mp I oyee D I :.f'Drlc::i l.y
<br />A and rc-rgcry
<br />
<br />1169-029
<br />
<br />I,WC.s1'Afjj:'I I"'""
<br />"J.T()~""'lIh1nsl ,fiR,
<br />EL EACH AU,;!ULNT $ __..
<br />LLCHSFA."l~'EA.E!-lF'l.C~:. ~_..._
<br />E.L DISEASE. POLJCY <JlI<'IT S
<br />
<br />..~-
<br />
<br />06/01/2002 06fOln003
<br />
<br />$500.000 Eoch
<br />Forgery $75,000
<br />
<br />Df:.6eRr~tc>>. OF OPWlraNS'LOCATlO~I.'VE.IIICl.e.fUCUlSIO'-lSJ.l)OI'l) BY ENDOR9E!MErtn~EClAL PROVJ31Qrtll
<br />
<br />Rp.: Gn'lnt
<br />Gert.ific.1;.e "olders 8:-C rH3TTll!d as 8ddit:io'1ilf insured per" attatched endorsmT1ent
<br />
<br />L
<br />CERTIAc,.,rE HOLDER
<br />
<br />, X I P.ODrTlDIOPJ. IIiISlJ~ED: INSlj~eR LETTER- A
<br />
<br />CANCEUATION
<br />
<br />Cit~y of S-:.Int.ti An,,:, its otTic-2r's. agents,
<br />Olllutvyee:s I:L- repr-csenLatives
<br />20 ~;IVIC Center' PlllZI'l
<br />S8nt.a k:a, eA 92702 -1988
<br />
<br />~OI)L.D Al;'I OF Tll,. ASOV.Ii 1lE:&Cfl.IBl'!D POUC/EIJUF ('JIlIlir.FI.l:.l:Do Bf:FORl'! T'4F
<br />EaXf"IRATIO'" DATE lHERED~, THE ISIMJIN<-I CDMf"AI'i'(W'LL ~~ "'~lL
<br />3Q,,_ o-AYI!IWIlnTEN tjOTICe. TO 1l1EGEKTlFICME I;()LOSR NIUIIEDro TlIE "EFT
<br />--~-~~--~X
<br />--x.-____~XX](X)()()(
<br />AlJTHa~EDR[,"RE5"EiNTA~. --1."'-) " ..
<br />Teri N{;>wcomoo /- d. 1. L '" l .e.J,'? j
<br />@ACORDCORPORATION19U
<br />
<br />ACORD 25-S (7197)
<br />
<br />At'.
<br />
<br />
<br />D Al:l
<br />~
<br />
<br />ISTINE LEE SHA, .
<br />,i,ty City Attorn"
<br />
<br />r
<br />
|