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<br />ACOB.Q.~ CERTIFICATE OF LIABILITY INSURANCE
<br />'ROOue... RICE LINE INSURANCE SERVICES
<br />15342 HAWTHORNE BLVD
<br />SUITE #207
<br />LAWN DALE
<br />J~1~)~.!7gg____.______ .. ___._______
<br />
<br />DAU (MMIDDIYY)
<br />1/1412003
<br />
<br />THIS CERTIFICATf IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER, THIS CERTlFICATE DOES NOT AMEND, EXTEND OR
<br />AL TEIIt THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />;ANTA A~
<br />:OVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLtCY PERIOD INDICATED. NOTWITHSTANDING
<br />A"" REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIfiCATE MAY BE ,SSUED OR
<br />MAY PERTAIN, THE IN$UAANCe: AFfORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSION!!: AND CONDmO~g O~ SUCH
<br />POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />1~~'r-'d'-~~;;~;AA~~i"-'-"'''''T'-'m- .. -~~Cv NUM";"" ~ ',. . --"-., ~cVl:"Il:T1~'!TP8ifl E?Ji6~N r'" ---'--'--'-""'~"'-LiMns'-~"~'---'-'-"'.
<br />; ",GENERAL llAltUT'f i, EACH OOCY~RENCE " J IS" 1,000,000
<br />
<br />· . ~f1==r.r= CA'....'" """,,.. "Hmo.. 1~~~::'i.~~J!
<br />I f-G~l~;~~~'=~;~~~~~;P~~SPER i;~~~~;~::~~~;;;Gr:-~ ~~~~~~~-
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<br />! -i'~ POLICY "--"1 ,jRg,: r-l Loe 1..------...- .--.....----
<br />r ; AUTOMOBII,..!: 1,1"811.1TY
<br />I ,--'1 'NY'UTO
<br />'-....1
<br />: I A\'I,. OWNED AUTOS
<br />~'..-'l
<br />3 I , I SCHEDULED AUTOS
<br />l-.. -I HIRED AUTOS I
<br />- " I
<br />I NON-OWNED AUTO!! I
<br />.:! _B_,!sl,!!s~!,~~o~}_I..__ ,
<br />
<br />CA 92703
<br />
<br />I
<br />-'-"~-'NS':;Re.-~:-SCOi'iSDAi:E iNSURANCE COMPANY-- ------. -
<br />!"!.;;R~~~f2PAJ~~~!!ANi::~ co~!AIIIY ---===___ ___
<br />INSURER c:
<br />"iN'SU.AE~'-""._--_."-~"'---_._._'-" -,- --""'~,'~"--""" .___._n,. ".
<br />
<br />I'INSUAEA'~~"'- ---'---,,.',,,,,,---.-,, -.---.--..--,'..-----..-...----..- ..--
<br />
<br />INSURERS APPORDING COVERAGE
<br />
<br />CA 90260
<br />
<br />N"S-URED--
<br />UNITED SAMOA ORGANIZATION
<br />1617 WEST RICH LAND AVENUE
<br />
<br />779120005
<br />
<br />11113/2002
<br />
<br />11/1312003
<br />
<br />COMQtN6:0 SINGLE LIMIT f."
<br />,,(EsElcOklant)
<br />r--.-......-..--- ....-----..
<br />I BODIL I( INJURY S
<br />(PerpQf$On) ;
<br />---. ,-,-----~,...
<br />, 80011.. Y INJURY ,
<br />I(Pli!rljl~dent)
<br />i.;ROP'~~-~MA;-.". ~.,.-._.__.__.
<br />(Periillcddt!nl)
<br />
<br />1,000,000
<br />
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<br />li- l~.es. LWIILm'
<br />, : OCCUR
<br />1-".
<br />1,,- OEOUCTIBLf
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<br />
<br />APl-l"'O~' i...0
<br />
<br />
<br />j AlfrOONLY-EAACCIDENT S
<br />!""____...____m" "....._ _.0_"._ ..__._._.____....
<br />I OTHERTNAN .e:AA~..~~"'.__._.__.
<br />i AUTO ONL "t': AGO ! S
<br />
<br />i GAAAGE LIABIlITY
<br />.-] ANY AUTO
<br />,
<br />
<br />: C1.AIMS MAG!
<br />
<br />TO FO 1.,1
<br />I
<br />I
<br />
<br />E.4CH OCC.URRENCE
<br />.. _0__'--'-."..'.
<br />
<br />.
<br />------~-_.
<br />.
<br />.
<br />
<br />"-1
<br />
<br />..AGG~GA:!:E
<br />
<br />RETENTION .$
<br />: WOflKEfI/IS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
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<br />DCi--"" C>l) "II mey
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<br />l... ."LTORY UMITotL.._1JR~__...m
<br />I E.L EACH ACCIDENT I $
<br />.E.~'. ~.I,~.~.~.~~. EA E;~~D;~~Ei":~-'====_..
<br />E.L. CIS~6E - POUCY LIMIT 11
<br />
<br />I
<br />~ OTHEIt
<br />
<br />
<br />~ ~AIf'T10N OF O.E"'TIONSlLOCATION'IV~CWIEX.LUSION' AOO'O OY ENOOR.IUINTISP.CIAL PRoVISIONS
<br />,
<br />: ~ION PROFIT ORGANIZATION
<br />i {:ITY OF SANTA ANA, IT'S OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL
<br />[SURED AS RESPECTS THEIR INTEREST IN CONNECTION WITH THE NAMED INSURED.
<br />
<br />
<br />C ERTIFICA TE HOLOER AllOIT1_.INSORlto, INOURER LETTER, CANCI!LLATION
<br />~ liHOULPANY OF THE ABOVE OISCRI8!:D Po\"lCIE5 BIClAtIICELL'ED BEFORE THE EXPlRAl10H
<br />CITY OF SANTA ANA..CDBG M-2S OATE TNlRliOf, THE ISSUING INSURIR WI.L <NO..vaR TO MAIL ~ DAYS WIlI1'TON
<br />COMMUNITY DEVELOPMENT AGENCY ... NOT1""TOTHECERT1"CATlHOLD'RNAM'DTOTHELEI'T,~
<br />
<br />,P.O. BOX 1988 M-25
<br />
<br />I SANTA ANA
<br />
<br />'ji.:ORO 25-S (7/97)
<br />l.\t lPWV1.~.601'l1r1<lI03.1e:.2:lby U,...N"",,,
<br />
<br />CA 92702
<br />
<br />
<br />RO CORPORATION 19BB
<br />~F "".0.1
<br />
<br />l"P' LI"Wvt.9.6 on 1/14/00,1&;24 by U$~9me
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