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<br />From: Robin Rabune At RS11nSlJrance Brokers, Inc. CJl..#(J18~:::44 l-axlU: {-14-'.)"I0-4..::l1 lQ: \/'VIIUl; f'\. 11"..H"<I" '..JOr-.
<br />
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 ~~ DATE lMMlDDtvY'N)
<br />THOMAS3 07/:1.9/06
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATlCN
<br />R.S.L Insurance Brokers, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />CA LICENSE #0782244 HOLDER. THIS CERTIACA TE DOES NOT AMEND, EXTEND OR
<br />2801 Bristo~ street #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Costa Mesa CA 92626
<br />Fhone:114-546-6616 Fax: 714-546-4457 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURlO:D P-z.C5t:b- lOti 'NSURER.''': , 26905
<br /> CIlOrtw:y If,l;tionOl;.l :z:ncw::=". C~. ,
<br /> iNSLRER 8 I
<br /> .~. _.ri",an capacity ntt.-l(Cl; I
<br /> Wil~ie A. Thomas DBA: I INSURER C:
<br /> Thomas Land c~earinq Company
<br /> 2170 W. Esther St. I INSURER D
<br /> Long Beach CA 90813 I iNSURER E
<br />
<br />COVERAGES
<br />
<br />TI-1E ?CLiClES OF iNSURANCE liSTED 8ELOW HAVE 3EEr~ ISSUED TO THE iNSUR@Nl>.MEOABOVE FOR THE POLiCY PE'<JOD I~ICATED_ NOTVVITHSTANDING
<br />ANY REOUIREME!fT. TERM OR CONDITiON CF .<\NY CONTRACT OR 0THER OOCUMENTWITH RESPEG TO VVHICH THIS CE:'<TIFlCATE W\.Y BE iSSl:ED OR
<br />!VIA.Y PER fAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREJN rs SU8..;ECT TO ALL THE TERMS, EXCLUSICNS MO C-CNOITICNS OF SUCH
<br />POliCiES_ AGGREGATE liMITS &10WN MAY HAVE 8ffi\J REDUCED 8'l' PAlO ClAJMS
<br /> '~'i!~IMMIDONY): I'DATE{MMIODfV'() I -
<br />L1R SRD T'tPE OF INSURANCE POLICY NUMBER LIMITS
<br /> ~ENERALUABILJTY I 8\0-+ OCCURRENCE 1$2,000,000.
<br />B I X i C0MMERCIAL GENERAL LiA8ILlTT PNG 0000893-03 04/30/06 04/30/011 PREMISES(E-aL<Jcc~eIlce) $ 50 ,000.
<br /> c=f=J CLAIMS MACE [!] OCCUR MED EXP (Any OM person) $ 5,000.
<br /> P"RSONAL & ADY IN.jUfI'f $ 2,000,000.
<br /> ~L AGGREGA1E"M'T APPLIES PER ' GENERAL AGGREGATE 1$2,000,000.
<br /> i PRODUCTS - COMP/CP AGG 1.$2,000,000.
<br /> i POLiCV n j~2T n LOC i
<br /> ~"O."E ".,,"" ! i COMBINED SINGLE LIMIT
<br /> $1,000,000.
<br />A ANY AUTO BAP:1.48395 09/:1.0/05 I 09/:1.0/06 (EsacCI(1ent)
<br /> I
<br /> ; ALLOWNEDPlJfOS ! 80DILY IN.;LRY "
<br /> ~ SCHEDULEQ AUTOS (per;lers.on) I
<br /> , HIRED AUTOS BOOll y iNJURY I,
<br /> ! NON-OWNED AUTOS I (Par aC~ldent)
<br /> H i PROPERTY GAMAGE I
<br /> {ParaCCJtlsnt) ,.
<br /> I : GARAGE LlABlllTl' I 1 I ~~y - EAACC:OENT ,
<br /> I
<br /> U"''lYAUfO OTHER THAN EAACC ,
<br /> ,
<br /> I ! , AUTO ONLY' AGG ,
<br /> I
<br /> I EXl:ESS.'UMBRELLA UAelLlTI' I i EACH OCC:URRENCE ! ~
<br /> o '~CC;jR j~ CLAIMS ,\o1jl.DE AGGREGA.TE ,.
<br /> , " i I.
<br /> H ~ED~n8LE " !'
<br /> ~NTION . I "
<br /> WORKERS COMPENSATION AND , iH)~~ t:~liTLg I I E~- i --
<br /> EMPLOYERS UABIUTI' -
<br /> ,ANY "ROFRIETORJ?ARTNERIE:~ECJnVE ~"-ACCIOENT [:1:
<br /> OFFICERiMEMEER EXCLUDED? ! I E L. OISE.~E - EA E:-..IPI.QYE::.I -$
<br /> IfY<Js.dascflbaundar , ! F.L_DISEASE. ;;lOLiC'{'Jr.1IT I:s
<br /> SPECiAL PROVISIONS balow
<br /> OTHER I ! I
<br /> I
<br />i ,
<br />DESCRIPTION OF OPEItATIONS r LOCATIONS f VEHICLES I EXCLUSIONS AODED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />6/6/>06 : LIMITS ON l3ENERAL LIAB INCREASED ro $2,000,000_ 'l'lIE CITY, ITS
<br />Ol!TICERS , EMPLOYEES, AGENTS, VOLUNTURS AND REPRESZNTATIV'KS HAVE BEEN
<br />REQUESTED TO BE NAMED AS ADDITIONAL INSURED IN RESP'ECTS ro 'l'lIE AUTO
<br />LIABILITY AND GENERAL LIABILITY.
<br />
<br />CERTlFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br />SANTA -3
<br />
<br />SHOUlD AN'( OF THE ABOVE CESCRIBED POLICIES BE CANCB.LEO BEFORE THE EXPIRATION
<br />
<br />DATE THEREOF, TI-IE ISSUING INSURE:R WILL ENOE:A\lORTO "'AIL ~O
<br />
<br />DAYS WRITTEN
<br />
<br />CITY OF SANTA ANA
<br />ROSS ANNEX
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA CA 92701
<br />
<br />,'lOTIe:: TO THE CERTIFiCATE HOLDER NAMED7Q THE LEf7. aUT F.-'\JLURE TO DC SC SHALL
<br />
<br />IMPOSE NO OBLIGATION OR UABILiT'f OF ANY KIND UPON THE INSURER, rrs AGENTS OR
<br />
<br />REPRESENTATIVES.
<br />A~ REP~TATNE
<br />~. 0/..4--? .r -I ~.
<br />
<br />ACORD 25 (2001/08.
<br />
<br />@lACORDCORPORATION1988
<br />
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<br />
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