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ACOSTA ASSOCIATES 3 - 2007
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ACOSTA ASSOCIATES 3 - 2007
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Entry Properties
Last modified
5/28/2015 10:26:13 AM
Creation date
6/10/2007 9:47:39 AM
Metadata
Fields
Template:
Contracts
Company Name
ACOSTA ASSOCIATES
Contract #
N-2007-060
Agency
Parks, Recreation, & Community Services
Expiration Date
1/31/2008
Insurance Exp Date
2/11/2008
Destruction Year
2013
Notes
See Workers' Compensation Declaration form signed by Robert A. Acosta
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'7 ' ^55- North American Amusement p 1 <br />ACORD_ CERTIFICATE F L BILI INSURANCE �5 10 0 <br />=':xi A.�lled SpeClal t7 3- <br />OP TeJ s THISCERTIFICATE IS ISSUED ASA MATTER OF INFORMATION <br />` <br />85 N.E. LOOP 410 ONLY AND CONFERS NO RIGHTS UPON THE CEI(TISCATE <br />I HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Suite 600 FR TH .OVERAA AFFORD DRY TH PO <br />San Antonio, TX 78216 <br />North American Amusements, Inc, <br />11101 Calabash Avenue <br />Fontana CA 92337 K1,2007-060 <br />THE POLICIES OF INSURANCE LISTED BELOW HAVESE&YISSUE-O TO THE NYSURED NAMEDABOYE FOR THE POLICY PERIOD INDICATED, NC TYdO1STANOING <br />ANY REQUIREMENT. TERN ON CONDITION OF ANY CONTRACT OR OTHER OOCJNENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY 9E ISSUED OR <br />MAY PFRTNN, ME 9JBURANCEAFEDRCEb BY THE POOCIES DESCRIBED HERpN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON01 f1ONS OF SUCH <br />F'Ouiae . AQOIE(L17E iJN9T8 SHfNN OAAY /NYT: BEEN REDUCED BY PNO CWN19. <br />NEN <br />FOLWIARIIIER <br />EpJCD64e w I r0.xV HPRAl10N <br />mvm.LVA <br />X'cv�llworL LvdARY M7MT2856 <br />02 /11 /0 <br />02/11 /0 <br />CE <br />1,000,000 <br />50,000 <br />n m <br />cwllcLU� U occw <br />DeAL LAavINUVY <br />1, 000, 000 <br />10, 00O3 000 <br />1, 000, 000 <br />,gNtArcR .NB JA vec <br />'1 <br />iI1rMa. <br />J•� <br />•l1ALl11Y <br />AJnALm <br />M7MT2856 <br />02/11/07 <br />D2 /11/08 <br />LbMIE05FYiE1gLT <br />Ra <br />1,000,000 <br />➢mLVNLnn <br />R,wnF�.l <br />1 � X <br />'�'0""NOi <br />bi'IEDJL�ANTOG <br />CJGLY WJUMY <br />cvrAaNrl <br />� <br />4pEp.LLlfP6 <br />wwwEePA:rlcs <br />DAORRIYpAMAQ <br />WrEPme,X' <br />—_ <br />EAA,'.{iE <br />WSUT' <br />AUTO d1LY- FAJOCJOPM <br />I <br />Mf/J.IIfO <br />'. OTMEA i4Y1 <br />'. AVPOOlLY: ADQ <br />A�IaoyR <br />���o----m,,,sarmNLUweum <br />�OWNB NIfL <br />M7XT2857 <br />02/2.3-/D? <br />02 11 OBir <br />Occ iwg <br />1, 000, coo <br />r— cute <br />1.000.000 <br />M7XT2858 <br />02/11/0 <br />02/11/0 <br />AC" CCCUR. <br />GGREGATE <br />I 3,000 OOC <br />1cNIm,I,AIeLNEARBPIAxo <br />We cMU- om <br />-- '- '�-" -ti <br />,NIY PNCPM1I(fgiRAKtNEAlFA9VrrvE <br />Q9i'2RLNEEII ERT.ICB]9 <br />' I, PeJBOPWV <br />A .EA hOYEE <br />f <br />LL - PCLL.'LPIR <br />! <br />I <br />ILCamrw w PPPJUrI V q r Eaumrs r vEiICLSS r cr<cwHwa Aolwo BY duon�IErr r>mxuLrpPNSONc <br />?,.D=ONAL INSURED WITH RESPECTS TO THE OPERATIONS OF TEE NAMED INSURED: <br />CTTY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS AM) BOB <br />,I ACOSTA ASSOCIATES <br />LCCA^_' =OW: EL SALVADOR PARK, 1825 W. CIVIC CENTER, SANTA ANA, CA <br />_nATTiS: 08/25/07 THROUGH 08/27107 <br />'" = "E C'_TY OF SAN^_'A ANA <br />rxownANreP iNeAawseeaeareo Fm Mftffi ANeeJJm aewan,e vnw+� <br />a : CIVIC CENTER PLAZP. <br />9ARTxeMti,TIE BaNND I9 WIFAWILLYiYiOroWL _i0 PAnw9mEN <br />XXA CA 92701 <br />ABxIroTNECDmBGt9N0tIlDlN.WmroRa LTPT, DSf/IiIitTOMLriIIUIIr <br />J�MBrII uuomaPOSVmIa�� <br />f <br />AunwalelP /� <br />J <br />A ^ ^40 26 f2001M) <br />r_; FORM <br />I Q ® ACrD CO iPORATION 1999 <br />
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