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,I I 711 W, 17TH STREET, #A-10 COST A MESA, CA 92627 CERTIFCI.\TE OF INSURANCE 'wi 1~~/~;/fo~~E PRODUCER Cert# 4357 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND HOLBERT INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE P.O. BOX 120B DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE SAN CLEMENTE, CA 92674-1208 POLICIES BELOW. (949) 492-6138_ FAX (949) 361-4079 1..- fch -) I ,.1f1I COMPANY iA A TRAVELERS INDEMNITY CO OF IL COMPANY B COMPANY C COMPANY o COMPANIES AFFORDING COVERAGE INSURED WOMEN HELPING WOMEN I COVERAGES -~ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. C L aT POLICY EXPIRATION I -~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE LIMITS TR, DATE (MMlDDIYY) DATE (MM/DDJYY) ! G;.NERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 880-466P105-A OCT 28 02 OCT 26 03 _.. X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 2,000,000 FLAIMS MADE ~ OCCUR. PERSONAL & ADV INJURY $ 1,000,000 A X OWNER'S & CONTRACTOR'S PROTo EACH OCCURRENCE 1$ 1,000,000 - - I FIRE DAMAGE(Any One Fire) 1$ 300,000 I MED. EXPENSE(Any One Person~ :5 5,000 I AUTOMOBILE LIABILITY , - ANY AUTO COMBINED SINGLE LIMIT 1$ 1,000,000 680-466P105-A OCT 28 02 OCT 28 03 - , I-- ALL OWNED AUTOS BOD!L Y INJURY (Per Person) . SCHEDULED AUTOS AX HIRED AUTOS BODILY INJURY c-:-:- $ ~ NON-OWNED AUTOS (Per Accident) I-- PROPERTY DAMAGE $ ~RAGE LIABILITY AUTO ONLY - EAACCIDENT I' I I-- ANY AUTO OTHER THAN AUTO ONLY: I EACH ACCIDENT :5 I-- AGGREGATE . EXCESS LIABILITY EACH OCCURRENCE . B UMBRELLA FORM I AGGREGATE $ _ OTHER THAN UMBRELLA FORM i WORKER'S COMPENSATION AND I STATUTORY LIMITS 1.-- _______J EMPLOYERS' LIABILITY EACH ACCIDENT ,$ i ASiASE-"POLlCY LIMIT 1$ THE PROPRIETORJ R:INCL A PPROVE~ AS TO FO PARTNERSIEXECUTIVE IlJ1SEASE-EACH EMPLOYEE I. OFFICERS ARE: : EXCL OTHER ,,( iJ Il 'a lA, l' C'.Y--<-.... 7 DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESISPECIAL ITEMS Lam" ' ( OPERATIONS OF THE NAMED INSURED Deputy CllY Attorney CERTIFICATE HOLDER AS ADDITIONAL INSURED CITY OF SANTA ANA, M-25 COMMUNITY DEVELOPMENT AGENCY PO BOX 2988 M-25 SANTA ANA, CA 92702 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.