|
<br />11/11/2002 22:47
<br />
<br />7148422538
<br />
<br /><I
<br />
<br />P/lGE. 01157
<br />
<br />ACQBD. CERTIPwCA TE OF LIABILITY INSb'RANCl;.ca~llU1 ....-
<br />"".,...,... 11J06l0..
<br /> !!!!.~ 1II1a IUUEl A5 ~. Mot. T1QH
<br />!lI.lAUI'9l'OD :U<lH.!.a :tu. AQ"Day ONLY AND CON_ NO RlQHTlI UpQH lJ11! CERT1flCATIi
<br /> HOUlf!R. TIllS CERTIFlCA,.. DOE" NOT AMeND. ElcrKNO Oft
<br />18'72 rlQ~i4a ... ate. 302D ALTEll THe CO\IERAOe AFFORDi.!> IlY Tlle POLlan ..LOW.
<br />H:UIlt..::tt:li$"tQ'Qi S.flClb QA 126lUil I IH$URIiR$ N'FOIlIllNG COVI!RAOt
<br />'hOD~,714-'41..28~ I
<br />JNSUIIlII!!O J 11GJU1tA: r1z:st N. t10",,1 :r". Co _dc.
<br /> Trc=.' Houss T8mporary .belta: ~.'
<br /> T In i'Q.ter _e, -./
<br /> P.O IiO~ 2737
<br /> Gar~ ra>". CA j.S~...737 -'" I
<br />I , r~~~Ii;
<br />
<br />CANC!LLATION _............"""1
<br />neo .-c;~ ,I. CAfClLt,ED vW-'''
<br />$MOV'.c. N(i 01' THe AaCWI ~"l t.t~ Wtl\. ..3.a....- CA'l1I wKl'f~
<br />o...tt ~tOf'. T'l1tl1..UIHI3IN8U.... WllL.)6qi ~ . "#-'vPp:."f..... V!' ~_
<br />.......... -~ATI"QU:)lR MIolID:l TO ntI L.I$,-r, ~
<br />r;O~!TQ .......... '..... _ "llt.,~;rlP"
<br />
<br />cOVIiRJ.GI!B
<br />
<br />n-'E :tOLtaiS 0#' IHltJfIAJlC! U8T'iD IQ.OW""VI!! eft'" l~ 1'0 M IN.U~ "'''Mie Ato'Vt '<'III TH; POUC'r' IIIiRlOQ 1~T'll:l. NO"TV'ln-lAr~NDIHG
<br />AJ.-Y ~elUl~, ~<lOft ~OFMYCDNTItJlGTOAOnu!" QOQ~'i'/lTlol AIiIPSCTTO WMItH THltl;lRllF'~Tliw.y" 1frllJC!C~
<br />w.VM!J::"AA, fHlII~ANCE~ IYlHI P'OI..1OI8 bl~MEO Nl;RSN ICSUIJL"1' TO AU 'n-l! ftlllMS, I7l:WSICN4 ANO COHCl'T1C~ Of' 8UCH
<br />~~.~f! U/ICfT$ StfJlM.l w.Y~'-'i fUiN ltiiOUCliJ IY"AID QJ.lMS.
<br />
<br />TY'PEOfIIN$iJRAIIl::e ,.;JucrMUMlU
<br />
<br />QiD'li'U.lo~Jli,./T"f'
<br />
<br />A ~:O'"';IlClAL~!"E...-""'MY CP7781061
<br />
<br />M --: WJM' UACII 0 O(:OUR I
<br />
<br />
<br />
<br />G'H'.~Te:LII\1lIT.P'l'\.let ~:I
<br />. n"", .
<br />X ' IIOl.ICV JE" lOC
<br />L~"u~O"L! UAlfLril' !
<br />I -- .N'r'MftO
<br />~ aL.L Ow+.l.~ AUNa
<br />IO;t;ouL!.O A,UlOS
<br />M~Q ALJTOI
<br />NQ"oI.QInIfoI20J,f/1'OS
<br />
<br />
<br />Of/U/02
<br />
<br />EACHOceu~
<br />IIrI"l Q,tMNilI tM'/CII'leI.1}
<br />,..eo&J'P(MY~W$Ot\l
<br />I P'iMOl~.AfN~dY
<br />j Q(HW~"'~~
<br />MOC\JI:U.CQUWPAOG
<br />
<br />06/16/03
<br />
<br />CXWBlteo 6iNQUi LMIlfT
<br />{l;I~"J
<br />
<br />IQO~Y ......Y
<br />t.....,.,.mnJ
<br />
<br />tIClO~. ",JURY
<br />(~,oe,"...)
<br />
<br />~P<I<TY,I'^"^"" .
<br />
<br />COAR-olLIA51l"l"/'V
<br />J.H't'4lJ"iQ
<br />
<br />
<br />IolITCC,",.,;,o.ACClOQIT .
<br />MN:v .
<br />-.
<br />.
<br />
<br />
<br />~~~~
<br />
<br />fACH(~'
<br />AGa"'QAT'I
<br />
<br />1>?>y,y.,e"'f!1. ~
<br />~ 5 ORC\<.
<br />\..ISP- E.. Mtorl1e'Y
<br />p.sS\S t' f--
<br />
<br />TC'"
<br />,.L. liACH M:Clot!NT S
<br />t..L..(ltml.fA"""~'l'1 .
<br />I.l. cmaAII! . POUC'l' I,.lMrT t
<br />
<br />IXGllU ~UTl' 'I
<br />""""" [JCUIIolO",,",
<br />I
<br />i
<br />
<br />
<br />~UC1'IiI.E
<br />RmJ<!"'"
<br />WOfO<CR.I COMflEHtl...noM At!O
<br />'''''to'ffltf'L.tAlttrrY.
<br />
<br />; L
<br />I ' i
<br />I <<:)lCl~cetlfYlN~Jm"ICc.AL.rt\O"ml
<br />OEIiC""'ION{J"o'lRAn~$I\.oc....nQNSNlMl~CI,.U$ Aa~tl;t J!lmployee. aJ)d Volu~t..rl lU'fi1 t:,an14Ic3
<br />IC1ty ol santa Ae&1 it. Officer., t~8i~' int.c..t 1ft eOnD.c~ion wi~h e~~
<br />.. s(~itio~al 1~.ur.d .. r..p*ct.
<br />,
<br />I ,,~cl 1.11.ured.
<br />
<br />
<br />CEMTIf'lCATE HOLDER
<br />
<br />,on-al'l:
<br />
<br />N ,IrrOornoi'Vl\. ....slJR'O: I....\,I~ tnTM:
<br />C::::S:.nlo
<br />
<br />ciey ot Santa ~a - CDa~
<br />Com=~nity Develop=.n~
<br />"",ancy
<br />P:O. a.x ~gee ~.~5
<br />S.."too >.n& CA 9nO~
<br />
<br />II:-~~
<br />
<br />
<br />w_
<br />.]. 000 000
<br />1100 000
<br />III 000
<br />01000 000
<br />01 000 000
<br />01 000 DOO
<br />
<br />.
<br />
<br />o
<br />
<br />o
<br />
<br />.
<br />.
<br />.
<br />.
<br />
<br />I
<br />I
<br />\
<br />
<br />U:l~~~1.'.
<br />
<br />I
<br />ACOM 23-S (TIH\
<br />
|