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<br />/ ", THIS CERTIFICATE~ AS' A MATIER OF INFORMATION
<br />" ., ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />jtington Pac~f~c Ins. Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
<br />/672 Florida St. Ste. 302D ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW,
<br />
<br />,iuntington Beach CA 92648 COMPANIES AFFORDING COVERAGE
<br />
<br />COMPANY
<br />A
<br />
<br />Fulcrum Insurance Co
<br />
<br />Robin Hatfield
<br />_Phon~No 714-841-_G28L F?J(No
<br />INSURED
<br />
<br />--
<br />
<br />COMPANY
<br />B
<br />
<br />Thomas House Temporary Shelter
<br />Tim Foster
<br />P.O. B9x 8693
<br />Fountain Valley CA 92728
<br />
<br />COVERAGES
<br />
<br />THiS IS TO CERTIFY THAT THE POllCll.:S OF INSURANCE liSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AGOVE FOR THE POLICY PERIOD
<br />INDICATED. NOT\.liITHSTANOING ANY RF.QUIREME:NT, TERM OR CONDITION OF ANYCONTR4CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTlFICAn:: MAY 81:0 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI~,j IS SUBJECT TO ALL THE TERMS.
<br />EXCLUSIONS AND CONDI710NS OF SUCH POI.lCI(S LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />----.-..------,----1 POLICY EFFECTIVE POLICY EXPIRATIO~T---.
<br />ET~ TWE OF INsurV,NCE POLICY NU,\1BER DATE (MMIDDfYY) DATE lMMIDDfYY) I
<br />
<br />COI/,PANY
<br />C
<br />
<br />COMPA~~Y
<br />D
<br />
<br />"
<br />
<br />LIMITS
<br />
<br />GENf'RALlIAGllITY
<br />A xl COMMERCIAL GENERAL LIABILITY CPJ.002551.-02
<br />:~'TJ ClAIMS MADE ~ OCCUR
<br />OWNER'S &. CONTRACTOR'S PROT
<br />
<br />06/16/01
<br />
<br />GENERAL AGGREGATE $1.,000, goo_
<br />06/1.6/02 PRODUCTS-COMP/orAGG S Included
<br />
<br />PERSONAL & ADV INJURY
<br />EACH OCCURRENCE ~~ 0 0 / 0 Q.g_
<br />FIRE DAMAGE (AflY Oile fire)
<br />MEO EXP (Anyone per;;on)
<br />
<br />AUTOM013ILE L1/,BllITY
<br />',NY AUTO
<br />ALL O'vVNED AUTOS
<br />
<br />COME!INF.D SINGLE LIMIT S
<br />
<br />SCHEDULED AUTOS
<br />
<br />BQDIL Y INJURY
<br />(Perpcf$on)
<br />
<br />HI~ED AUTOS
<br />NON-OWNED AUTOS
<br />
<br />BOOIL Y INJURY
<br />(Peracriderlt)
<br />
<br />s
<br />
<br />PROPERTY DAMAGE S
<br />
<br />GAR"G~~ lIABILny
<br />
<br />j :'" AUT~
<br />
<br />AUTO ONLY - EA ACCIDENT S
<br />OTHER THAN AUTO ONLY:
<br />
<br />EXCESS LIAO:LIlY
<br />
<br />EACH ACCIDENT S
<br />AGGREGATE S
<br />EAC! I OCCURRENCE
<br />
<br />UMlmr:t U, FOH/,\
<br />
<br />APPRO
<br />
<br />D AS TO FORM
<br />
<br />t,GGREGATE
<br />
<br />WORKERS COMPEt,SATION AI,JD
<br />EMPLOYEHS' LIABILITY
<br />
<br />CRI I NE LEE SH W
<br />Dep Ity City Attor ey
<br />
<br />
<br />OTHEf{ THAN UMBRELLA FORM
<br />
<br />THe: f'RorRIETO,U I INCL
<br />PNHNERSIEXECUTIV[
<br />OFI'ICERS ARE ~~~~. EXCL
<br />
<br />r-__
<br />
<br />
<br />UlSCr~lf'lION OF OPU{J\TIOlj$llOCATIONSNEHICLESISI-'EClfIL !l EMS
<br />'The ci t:y of Santa Ana is named as addi tianal
<br />endorsement.
<br />
<br />EL OIS~AS[. POLICY LIMIT
<br />
<br />s
<br />
<br />EL DISEASE. EA EMPLOYEE S
<br />
<br />insured as per att:ached
<br />
<br />
<br />
<br />
<br />SHOULD ANY or THE AflOVE DESCHiOED POLlCIES BE CANCELLED SErORE Tilt:
<br />EXPIRATION ot. TE TlIEf{Eor, THE: ISSUING COMPANY \';'i!.L ~~'-:'TO t..1A1~
<br />30 DAYS V>'r\ITTFN.r-JOTIC[ TO 1 Hl: C[RTlfICA,.-eHOLOLfl. t~AM[D TO TIlE LEFl
<br />~.d'/..tj,<;<:",Y;.'JgIJM~~X~~'0P~~lli<\;i>\'/-
<br />MXt)~~_~J<i~~~IIiXWJ{V<y* ____
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<br />
<br />SANTANp.
<br />
<br />City of Sant.a Ana,
<br />Development Agency
<br />P.O. Ben: 1988
<br />Santa kna CA 92702-1,988
<br />
<br />community
<br />N-25
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