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711 W.17TH STREET, #A-10 COSTA MESA, CA 92627 CERTIFICATE OF INSLIQANCE RECEI"....O OCT 02 2006 1~~/~~/fo~~E -cei-t# 79841THlsciRTIFICATE IS ISSUED ASA-MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE , DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE i POLICIES BELOW. i--~---------------__ __._ _______ _ ! COMPANIES AFFORDING COVERAGE IC-OMPANY----.--~------- -_____u__m___ W(f~EN HELPING WOME~_200;~~5~~-~-r:i::VE:RS P~R:ER:~~S~TY~ - ---- -~- : COMPANY i C i.COMPANY-----------------m------ L_ - _un. -.----__ - ._.~~ _!:l._____m_m.____ _________.. u__. ._.__._______ _____.. --"---'---. -~._'-'~-'-'-- ----~-.._._-------------_._- PRODUCER HOLBERT INSURANCE AGENCY P.O. BOX 1208 SAN CLEMENTE, CA 92674-1208 (949) 492-6138 FAX (949) 361--4079 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO j- .- mTYP~ ~~~SURANC-;--+ POLICY NUMBER POLICY EFFECTIVE L TR: DATE (MMlDDIYY) - GENERAL-LIABILITY------- , ------r X COMMERCIAL GENERAL LIABILITY 680--466P105A OCT 28 06 . -.-----,- ----.-.---------------.- -~-----------_._-------_.- ..--------.. .--- POLICY EXPIRATION DATE (MMIDD1YY) 1------------.---.-.- LIMITS CLAIM" MADE X--. OCCUR. OCT 28 07 .-.---1-..------ I GENERAL AGGREGATE ; $ 2,000,000 !-~~----_.._----..__. _ -- '__'1_ '----..... .~_... .....--.-.. - ; PRODUCTS-COMP/0PN3G. $ 21~0G.OOO i-~""------'--- --- !~ERSONAL &~DV~JU~~ ___1$ __ 1 ,OOO,~OO lEACH OCCURRENCE *____1 ,000,000 F:=::'':.'~1:-=-=0~:;~~- ! COMBINED SINGLE LIMIT $ 1,000,000 - hm._. --- ._.___..__ ..-.--1._. ~ x_~~~'_'om~O.'''O;_1 iAUTOMOBILE LIABILITY ; I i ANY AUTO 680--466P105A --t--- I OCT 28 06 OCT 28 07 ALL OWNED AUTOS SCHEDULED AUTOS A:X~ HIRED AUTOS r X -; NON-OWNED AUTOS ;- -1 EXGESS LIABILITY + -. --- --_._h_.. : UMBRELLA FORM i D_T~E~:rH~~~BR:LLA ~___~___ i WORKER'S COMPENSATION AND i : EMPLOYERS' LIABILITY ! i I" I T I i BODILY INJURY i (Per Person) ! $ i-- -I I i BODILY INJURY ! $ 'I I_(~~~~~:~t) _0000_ -1 ) I -- -~------- '--_.--!:;;~:;~:;::'DENT~i : i IOT;:iERTHANAUTO-ON-LY~ . ! 1- __0000_ ------ ---L- I 1------. EJ\C:ciJ~~~*-~-- -. --------i---..---. -1--.--.-------------1.- -. --- . i EACH OCCURRENCE $ I j-AGGREGATE--- li- 1-- /:~;:u;~=r:~- , .- ---.-...---____ ___ 00_._ _ _ __~ : D:SEAEE.POUC'/ 1l~11T . l' : GARAGE LIABILITY ANY AUTO ! THF PR0?R~:T(H~J "ARTNEI~S/EXECU riVE OFFICERS ARE: OTHER INCL I EXCL _.L__ DISEASE-EACH EMPlOYEE-- i $ DESCRIPTION OF ClPEAATIONSlLOCATI6NslVEHiCLEStSPeCIALITEMS------ ---___ OPERATIONS OF THE NAMED INSURED --- -. _n _ --_.__00._ _._1 ------"---"-~j~/.,; } -Als...:rG -FOt.~!~-- __m ~:".~.: . J/ __ .._-_.~~ ,', ':'J~:.:I?1t City i'-\. CERTIFICATE HOLDER AS ADDITIONAL INSURED -..----.-----.-- _. --~----.- CANCELLATION .... --.- -. ----- --..- ..._____m____ .----.-hF~~~~~~~D~~~~:~~:,i~i~ii~~igg~~~~Eil~ii~~i~~~r~E 30 · ~~!:;:.~"gi:;g~ii,\':I:=~~,:::';~~;:';'~,~'!;; ANY KIND UPON THE COMPANY, ITS AGENT~ OR REPRESENTATIVES. I , I 11-;;'uTHC)FlIZEDR . - -. ------ -- ---------Ji. CITY OF SANTA ANA, M25 COMMUNITY DEVELOPMENT AGENCY PO BOX 2988 M-25 SANTA ANA, CA. 92702 - -. "'h? ;.j~ --------,,-- _.-------------'-----~..._--_. ^ l- t.