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ADDITIONAL INFORMATION CERTIFICATE NUMBER <br />' 303984 <br />PRODUCER COMPANIES AFFORDING COVERAGE <br />COMPANY I: White Mountain Insurance Co. <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 />TEXT <br />WORKERS COMPENSATION <br />POLICIES <br />Carrier <br />Policy <br />Number <br />Eff. Date <br />Exp. Date <br />State <br />(0) <br />American <br />Home Assurance Co. <br />RMWC <br />2920280 <br />10/1/2006 <br />10/1/2007 <br />CA <br />(B) <br />American <br />Home Assurance Co. <br />RMWC <br />2920292 <br />10/1/2006 <br />10/1/2007 <br />AK,AL,AZ,CO,CT,DC,HI,IA,ID,IN,KS,KY,LA,MD,ME,MN,MO,MS,MT,NC,NE,NH,NM,OK,RI,SC,SD,TX,UT,VT <br />(C) <br />Illinois <br />National Insurance Co. <br />RMWC <br />2920289 <br />10/1/2006 <br />10/1/2007 <br />MI <br />(B) <br />American <br />Home Assurance Co. <br />RMWC <br />2920287 <br />10/1/2006 <br />10/1/2007 <br />FL <br />(B) <br />American <br />Home Assurance Co. <br />RMWC <br />2920290 <br />10/1/2006 <br />10/1/2007 <br />NJ <br />(A) <br />AI South <br />Insurance Co. <br />RMWC <br />2920281 <br />10/1/2006 <br />10/1/2007 <br />GA <br />(E) <br />National <br />Union Fire Insurance Co. <br />RMWC <br />2920283 <br />10/1/2006 <br />10/1/2007 <br />NV <br />(C) <br />Illinois <br />National Insurance Co. <br />RMWC <br />2920286 <br />10/1/2006 <br />10/1/2007 <br />IL <br />(B) <br />American <br />Home Assurance Co. <br />RMWC <br />2920291 <br />10/1/2006 <br />10/1/2007 <br />PA <br />(B) <br />American <br />Home Assurance Co. <br />RMWC <br />2920285 <br />10/1/2006 <br />10/1/2007 <br />DE <br />(F) <br />New Hampshire Inc. Co. <br />RMWC <br />2920282 <br />10/1/2006 <br />10/1/2007 <br />NY,WI <br />(E) <br />National <br />Union Fire Insurance Co. <br />RMWC <br />2920284 <br />10/1/2006 <br />10/1/2007 <br />OR <br />(D) <br />Insurance Company of the State of PA <br />RMWC <br />2920288 <br />10/1/2006 <br />10/1/2007 <br />AR,MA,TN,VA <br />LIABILITY PROGRAM <br />Certificate holder is added as an additional insured far 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 />itional 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: 719-712-3726) <br />CERTIFICATE HOLDER <br />CITY OF SANTA ANA <br />ATTN: PURCHASING DEPARTMENT <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CALIFORNIA 92701-4010 <br />