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<br />ALLlANT <br />License Number: OC36861 <br />Phone (949) 756-0271/ Fax (949) 756-2713 <br /> <br />C\:rtificate Number:030 Date: 12il9!07 <br />VENDOR / CONTRACTOR LIABILITY PROGRAM <br /> <br />Named Insured: <br />Address: <br />City/State/Zip: <br />Additional Insured: <br />Contract Tenn: From: <br /> <br />LARRY SQUIRES <br />11702 BLUE .lAY LANE <br />GARDEN GROVE, C1\ 92841 <br />CITY OF SANTA ANA <br />12114/2007 to 12i14/20U8 <br /> <br />;v-~Qj7- /tf1 <br /> <br />Description of Contract: CLEAN AND REPAIR THE SPURGEON TOWER CLOCK <br /> <br />Contract Amount: 55,000 <br /> <br />COMMERCIAL GENERAL LIABILITY - NEW OCCURRENCE FORM <br /> <br />General Aggregate: <br />Products/Completed Operations Limit: <br />Personal Advertising: <br />Each Occurrence: <br />Fire Damag.e: <br />Medical Payments: <br /> <br />5 I ,000,000. <br />51,000,000. <br />5 I ,000.000. <br />S I ,000,000. <br />S 50.000. <br />S 5,000 <br /> <br />IMPORTANT! <br />Coverages are Limited to described contract. <br /> <br />DEDUCTIBLE: S I ,000. Each Claim, Including Legal and Adjustment Expenses <br /> <br />ANNUAL PREMIUM: <br />SURPLUS LINES TAX: <br />POLlCY FEE: <br />'rUrAL <br /> <br />Sgso.oo Fully Earned at Inception <br />$ 2656 Fully Earned at Inception <br />S 50.00 Fully Earned at Inception <br />$916.56 <br /> <br />CorvlP AN Y: <br /> <br />COLONY INSURANCE COMPANY <br /> <br />THIS COMPANY BINDS THE KIND(S) OF INSURANCE STIPULATED HEREON. THIS <br />INSURANCE IS SUBJECT TO THE TERMS, CONDiTiONS, AND LIMITATIONS OF THE POLICY <br />OF MASTER POLlCY #GL35Sl356 ISSUED TO VENDORS!CONTR.i\CTORS LIABLlTY GROUP. A <br />COPY OF THIS POLICY IS AVAILABLE ON REQUEST. <br /> <br />THIS I'LRTlFlC\lT M!\ Y BI: CANCELLl'I) BY THE INSl:RED BY SURRENDER OF fI'JlS BINDER OR BY WRITTEN <br />NOTICE ro THE CI JMPANY STATINlj WI.fEN C\NCLLLATlON WI LL BE LFFECTlVE. THIS CERTIFIC:\TE MAYBE <br />CANCELLED BY THE CO!\,lP;\NY BY NOTICE TO THE INSl,RFD IN ;\CCORD:\NCE WITH THE POLICY CONDITIONS. <br /> <br />. -; ',.;}?')... <br />.._", I ,0 . <br />\_" -<' I (;"ff...;-v :t.. ! y,......... T ::'-_'..J. ,/ <br />AUTHORIZED 51GNA TURE/COuNtERSIGNATURE <br /> <br />R.E. CH '\IX &. :\S<;OCI;\ TES INSCRi\!',CF BROKERS .11\(' <br />LJ(:~n~~ T\umbcr: 1)726213 <br />41 C\)rpofiltc Park, Suite .110, Inlne. C:\ <)2(;1)/; <br />PHONE (l)4917~2-4177 F.\X: (<)49)7::~-4172 <br /> <br />, ~ - '" <br /> <br />.. ~ ',.1 c/" <br /> <br />-~ <br />- .o'~7~..~'P/- <br />" '........,t;" . <br />" <br />