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01/25/2007 THU 16:50 FAX 7605910599
<br />Brooke Agency Services Cc, LLC
<br />810 Los Vallecitos Blvd Ste A
<br />INSURED
<br />Teleque On Fire
<br />1275 Phillips St.
<br />Vista CA 92083
<br />ISSO 1
<br />THE POLICIES CF INSURANCE LISTED BELOW NAVE BEEN OR R D
<br />ION
<br />REQUIREMENT, TERM CR CONDITOF ANY CONTRACT
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED sHEREIIN
<br />A I X I I I CLAIMS WADE
<br />CLS1235750
<br />BBAY11342230
<br />FL"LIT
<br />LITYCIAMAS MADECXL21778-02
<br />WORKERS COMPENSATOR AND
<br />EMPLOYENS LIABILITY
<br />ARV CERCERMEMBEER E% UDEED?
<br />MYee, descrhe entlar
<br />OTHER
<br />INaMERE
<br />N RESPECT TO W41C1 THIS C
<br />TO ALL THE TERMS, EXCLIJ
<br />4/15/2006 14/15/2007
<br />5/5/2006 5/5/2007
<br />4/15/2006 14/15/2007
<br />DESORIFTIONOFOPEPA11OW&CG1T10N5MHNICLESIESCLU&ONSAOD®BY EIDDRSENENTIBP t,,rCLkL ROa d r resental
<br />The City of Banta Ana, its officers, employees, agents, volRnteers and rep
<br />on the General L1ab11ty per the attached ecdnreement.
<br />A 10 days notice of cancellation given for non-payment of Premium.
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />tit
<br />Y PERNX) INOICATEO. NOTMTHSTANOING ANY
<br />ERRflCATE MAY BE ISSUED OR MAY PERTAIN,
<br />TIONS AND CONDITIONS OF SUCH PCl1CMS:
<br />UNITS
<br />EADHOCCURRENCE f 1,000,000
<br />DAMAGES S 100,000
<br />MEDEW a We enm s 5,000
<br />PetsoNALSA INJURY f 1,000,000
<br />GENERAL AGGREGATE f 2,000,000
<br />T f 2,000,000
<br />COMBINED SINGLE UMI s 1,000,000
<br />(Ea a -let)
<br />BODILY INJURY f
<br />(Per P—)
<br />WMYINARY f
<br />(Per ACPMerR)
<br />PROPERTY DAMAGE f
<br />(Per *wow)
<br />AUTOONLY�EAACaDENT f
<br />OTHER THAN E f
<br />AUTOONLY: AGO f
<br />s 2,000,000
<br />R 2,000,000
<br />f
<br />s
<br />s
<br />T^S STAT TH-
<br />El. EACH ACCIDENT S
<br />EL DISEA+E-EA TUAPLGY S
<br />Y T
<br />.Tues am named as additional insured
<br />:ANCELL.ATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />E)paATION DATE THEREOF. THE iSSUIW INSURER WILL ENDEAVOR TO MAIL
<br />30 DAYS YVNRTEN NOTICE TO THE CERRFrATE HOLDER NAMED TO THE LEFT. BUT
<br />FAILURE TO DO SO &TALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
<br />nmU ITSAGONTSORREpIIESBNTAMES.
<br />WTHOR¢EOREPRESENTATNE y:.._. .-.., _r.,..._.,._ ..«.....
<br />Eason Greenway/WH
<br />0 ACORD CORPORATION 1988
<br />AUTOIAOBEE ulm"TV
<br />ANY AU O
<br />$
<br />ALL OWNED AUTOS
<br />$
<br />SCHEWLED AUTOS
<br />X
<br />HMED AUTOS
<br />x
<br />NON4WED AUTOS
<br />CLS1235750
<br />BBAY11342230
<br />FL"LIT
<br />LITYCIAMAS MADECXL21778-02
<br />WORKERS COMPENSATOR AND
<br />EMPLOYENS LIABILITY
<br />ARV CERCERMEMBEER E% UDEED?
<br />MYee, descrhe entlar
<br />OTHER
<br />INaMERE
<br />N RESPECT TO W41C1 THIS C
<br />TO ALL THE TERMS, EXCLIJ
<br />4/15/2006 14/15/2007
<br />5/5/2006 5/5/2007
<br />4/15/2006 14/15/2007
<br />DESORIFTIONOFOPEPA11OW&CG1T10N5MHNICLESIESCLU&ONSAOD®BY EIDDRSENENTIBP t,,rCLkL ROa d r resental
<br />The City of Banta Ana, its officers, employees, agents, volRnteers and rep
<br />on the General L1ab11ty per the attached ecdnreement.
<br />A 10 days notice of cancellation given for non-payment of Premium.
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />tit
<br />Y PERNX) INOICATEO. NOTMTHSTANOING ANY
<br />ERRflCATE MAY BE ISSUED OR MAY PERTAIN,
<br />TIONS AND CONDITIONS OF SUCH PCl1CMS:
<br />UNITS
<br />EADHOCCURRENCE f 1,000,000
<br />DAMAGES S 100,000
<br />MEDEW a We enm s 5,000
<br />PetsoNALSA INJURY f 1,000,000
<br />GENERAL AGGREGATE f 2,000,000
<br />T f 2,000,000
<br />COMBINED SINGLE UMI s 1,000,000
<br />(Ea a -let)
<br />BODILY INJURY f
<br />(Per P—)
<br />WMYINARY f
<br />(Per ACPMerR)
<br />PROPERTY DAMAGE f
<br />(Per *wow)
<br />AUTOONLY�EAACaDENT f
<br />OTHER THAN E f
<br />AUTOONLY: AGO f
<br />s 2,000,000
<br />R 2,000,000
<br />f
<br />s
<br />s
<br />T^S STAT TH-
<br />El. EACH ACCIDENT S
<br />EL DISEA+E-EA TUAPLGY S
<br />Y T
<br />.Tues am named as additional insured
<br />:ANCELL.ATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />E)paATION DATE THEREOF. THE iSSUIW INSURER WILL ENDEAVOR TO MAIL
<br />30 DAYS YVNRTEN NOTICE TO THE CERRFrATE HOLDER NAMED TO THE LEFT. BUT
<br />FAILURE TO DO SO &TALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
<br />nmU ITSAGONTSORREpIIESBNTAMES.
<br />WTHOR¢EOREPRESENTATNE y:.._. .-.., _r.,..._.,._ ..«.....
<br />Eason Greenway/WH
<br />0 ACORD CORPORATION 1988
<br />
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