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<br />09/29/2006 11:43 2413390 <br /> <br />Sequoia Insurance Company <br />P.O. Box 1510, Monterey, CA 93942 <br /> <br />PAGL 03/05 <br /> <br />POliGY Number: SBP204616.1 <br />, l.uis E Rivera MD, In~ <br /> <br />,I <br />I <br />,I <br /> <br />City Of Sonta Ana Its Officers And <br />Employees, Agents ValuntHors And <br />Aepresent.tlves <br />20 Civic Center Pllze <br />Santa Ana, CA 927Q1 <br /> <br />I <br />, <br />BUSINESSOWNERS INSURANCEi"OLlCY <br />07/19/.2006 -')~c1.oratinn Number 001, <br />Policy ~ffcrtive from 07!l912006Io 07!l912007 at U:OJ AM L~t.l Time <br />- -- I <br />Insured: <br />Luis E Riv"ra "0, Inc <br />2222 S M~ln S~I <br />Santa AM. cpJ 92707 <br />I <br /> <br />J <br /> <br />Errell:tin <br /> <br />Mail To: <br /> <br />Additional Insured Policy Declaration <br /> <br />Youlare Itsrcd as an Addl(Hmal Insured under this pOlicy as per the attchcd. <br />~ <br />I <br /> <br />Agent: <br /> <br />Networked tn~unnct= Agents <br />988 McCo"rtney Road, <br />Or.." Valley, CA 959"~ <br />(530) 274.3102 <br /> <br />I <br />".€~ -do /0 <br />I /' <br /> <br />, <br />J__ <br /> <br />~OTE: In tb. event of CANCELLATION of this policy for non~p.)'mcnt or prfmium, " "'rftltn notice w,ilI be given <br />to thr Addilinnellmnltcd ten (10) days prior to the dTectiloe date or <::lUI.cell'atlon. U ,this poHcy f!i 't:lU1celled ror <br />any othu reason, . wtiltcn notice will bt given to Ihe Addttional Jnsured thirty (30) days. prior t. the: dTuttve <br />date of cancellation_ I <br /> <br />In I:h~ rvl'nt of NON-UNEWAL ofthi::! policy, 8 written notice will be f!:h..en to the 1.\ddif.iOnOllnSlJrcd sillty <br />(60) days prior '0 'be f.xplraUon date ot the policy. <br /> <br />Any lo!.1 is pAyable to,ithe Named Insured and the .Addilinnallnsurcd, 8S their iDU!~1I!5t 8pp~llr1\i 011 thl'i pnllcy. <br /> <br />D.le Prinlcd 07nl12006 <br /> <br />ADDlTIONAL'I'SUREO <br /> <br />It('IPI)<,-A).. <br />