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NUMBER <br />PRODUCER <br />Marsh, Inc. <br />1166 Avenue of the Americas <br />New York, NY 10036 <br />Telephone (212) 345-5000 <br />INSURED <br />SimplexGrinnell, LP <br />1701 WEST SEQUOIA AVE <br />ORANGE, CA 92868 <br />United States <br />WORKERS COMPENSATION POLICIES <br />COMPANY I: White Mountain Insurance Co. <br />LIABILITY PROGRAM <br />Certificate holder is added as an additional insured for General Liability and Auto Liability, but only to the <br />extent of the Named Insured's negligence. <br />The insurance will be primary and non-contributory, with respect to any other insurance carried by the certificate <br />holder, but only to the extent of the Named Insured's negligence. <br />Additional Insureds: CITY OF SANTA ANA <br />Project: WITH RESPECT TO ALL OPERATIONS <br />If there is a question regarding this certificate please contact JOANNA FAZIO <br />(Email: jfazio@tycoint.com Phone: 714-712-3726) <br />CITY OF SANTA ANA <br />ATTN: PURCHASING DEPARTMENT <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CALIFORNIA 92701-4010 <br />Carrier <br />Policy Number <br />Eff. Date <br />Exp. Date <br />State <br />(B) <br />American <br />Home Assurance Co. <br />RMWC6610498 <br />10/1/2005 <br />10/1/2006 <br />CA <br />(E) <br />National <br />Onion Fire Insurance Co. <br />RMWC6610504 <br />10/1/2005 <br />10/1/2006 <br />NV, <br />OR <br />(D) <br />Insurance <br />Company of the State of PA <br />RMWC6610503 <br />10/1/2005 <br />10/1/2006 <br />AR, <br />MA, TN, VA <br />(C) <br />Illinois <br />National Insurance Co. <br />RMWC6610501 <br />10/1/2005 <br />10/1/2006 <br />IL, <br />MI <br />(F) <br />New Hampshire <br />Ins. Co. <br />RMWC6610505 <br />10/1/2005 <br />10/1/2006 <br />NY, <br />WI <br />(A) <br />Al South <br />Insurance Co. <br />RMWC6610499 <br />10/1/2005 <br />10/l/2006 <br />GA <br />(B) <br />American <br />Home Assurance Co. <br />RMWC6610502 <br />10/1/2005 <br />10/1/2006 <br />FL <br />(B) <br />American <br />Home Assurance Co. <br />RMWC6610500 <br />10/1/2005 <br />10/1/2006 <br />All <br />Other States <br />LIABILITY PROGRAM <br />Certificate holder is added as an additional insured for General Liability and Auto Liability, but only to the <br />extent of the Named Insured's negligence. <br />The insurance will be primary and non-contributory, with respect to any other insurance carried by the certificate <br />holder, but only to the extent of the Named Insured's negligence. <br />Additional Insureds: CITY OF SANTA ANA <br />Project: WITH RESPECT TO ALL OPERATIONS <br />If there is a question regarding this certificate please contact JOANNA FAZIO <br />(Email: jfazio@tycoint.com Phone: 714-712-3726) <br />CITY OF SANTA ANA <br />ATTN: PURCHASING DEPARTMENT <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CALIFORNIA 92701-4010 <br />