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•/ • DATE f!AhtittYYYYYJ <br />CERTIFICATE OF LIABILITY INSURANCE 8/21/2009 <br />PFW-01 czR (949) 851-8804 SAX: (949')651-8842 THFS CERTIFICATE 15 ISSUED AS A mATrER OF INFORMATION <br />GSM Insurance Sarvicee ONLY AND CONFERS, NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Lie. #OD15612 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._ <br />30 Corporate Park $307 <br />Irving CA 92 606 INSURERS AFFORDING COVERAGE NAIL <br />INSUM--11F..Nsul=a.lus Inn CO <br />C---- , Inc. Insu, cRa,Great Diyicle Ins Co <br />500 S. Jefferson INSURSaG: <br />INSUFit.•R d: <br />Placen �a CA 92870 IN$J RE <br />COVERAGES <br />1;1EPOLlCIES OFI.NSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE. POLICY PERIOD INDICATED, NOPNJTMTANUING <br />AN•f REOUIREMENT, 'CERA! OR CONDITION OF ANY CaSIRAGT ON OTHER 00CUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />41AY PERTAIN, TFE INSUJFRANCE AFFORDED 8Y THE POLICIES OESCRIBE_O iHEREW IS SUBJECT TO ALL THE TERMS, EXCLUSIONS A,14DCONDITONS OF 9 UCH <br />1100' -IE$. AWREW, E LIMITS SFfOwN MAY HAVE KEN REMCED BY PAID CLAIMS, <br />MtBR <br />..'' <br />.. IMtTS'LR. NSR Ty 0EISU"H2POLICYNUMER YI4XA <br />a TxrtALLuBILm FACAVCctIA11 Knr $ 1,000,000 <br />TSA1ktdE 4d Rc^tTTfb <br />X 003tM01L.e1. r,ENERn�L 'LIAua.rrr ' _k'Nt,1ISk3 ae� ocsclnyl�gl .. s if10 OQ0 <br />R i I CLAM nrsr,E � X I OCCuR item 0200181-12 � 8/23/2009 8/23/207.0 qj�q rtAv"tins � S <br />PERSONAL & DCN INJlX / <br />__ ._. _ _ cFn rtALctaecaA S 2.000, 00,0 <br />r,�wl A1jGFW-JA, TrLIWTA.. r.IESrR M0ducr5casiP�.13PAGD t 2 ODO X00 <br />X f Palmy I ;' T LOC I _ <br />_ _ <br />Auit:ltOait.EClAam•IfTY COMBNdEDSINGLE :ILIITm i 1,000,0040 <br />X Auv A11 TQ <br />D AI.I,OWJ!:DPi+-0G 0200182-12 8/23/2009 B/23/2010 ROnILYlNJ4HY <br />S^T ULIL�L'AUT{iS (ForForwni S <br />X NIRfr;1 ti:Ti3K <br />10OILV IfJS.JL1i!` .. _....._ <br />it ION-OWTt�I AiTrn.. IpeT.urc)tienll <br />came i Coll Dori. t...r11<�v�"• . <br />'yoL v pkOPE 1TY'"'AGS <br />1 4 00 tpm aoldeA <br />I <br />RARASC LtADYITY AUTO ONLY• kA ACGIL;6Nr 5 <br />1 ANY MITO . EA RLC.. S _...... __._ <br />i OCHER T!iA,k <br />AVtOONLY. AGC, S <br />_EXCEWWWRELrLAV}A}7HJ7Y p „�..�•^^` - ~-� \til}'CIlUS'. C+,1CI16CLUi6iEFk:E b <br />,rY GtA:M3A6tLK I ��SCi. � AGGREGATE <br />I <br />3 <br />I ( DEDUCTIBLE <br />8 <br />AND MPL(7YERs*LIA0aJ7Y Y l ro X SN3Ya131diS9l _ . _ EH _ . <br />Awt opnEToNrARTNEfyuE-cAmvE: r -LL" RACICCur S 11000,000 <br />c�fl�E'sa exta.uc>E;nr <br />(ht,mlabrjlPNM 1523397-1D `8/23/2009 8/23/2010 ELMAEM19-rA@A9TLOYE s11D00ODO <br />___ rev.:; PF{ONXRlCW3 bebr D15FAFF • POt TCY r ulrr a 1 0 0 DOO <br />A MVERContractors ECpO 02aaisi-12 8/23/2009 8/23/2010 tach Doourraxioa a L'000,000 <br />Yollut-ion R4oxso4 e S 2,000,000 <br />s <br />i <br />DEBCRIp'TtIIN OF OFiW1T16N5 f LLM.ATIOpkSf V6HiCLEg! EXCL11Y7ONS AIX38DKY kttUONYEiTE.'VT'R 5PLClAL pR'JWlia•ONS <br />Tho VoTT•wral liability poltoy includai the City, of 9antn Ana, itF1 officlare, employesa, agenta,voluatears and <br />raprasantativos as acieu tiolial insured with regard tb work partormed by os on behalf of tho xam" Incurad wf urc rimcpirod <br />hY writtan contract.*Nxoopt 10 days for nonpaynart of premium. <br />SND ULD ANY OMMADOVE oatcFusen MXk.1IgS RECANCELL oaePine THE E%PatAnoh <br />City Of Santa Axis WETNEREDF,NEWLM.0INSURER %ILL*M)OM TAIL 30 _ DAYS WRrITEN <br />1)opartnant of Public Works NOTICE 10THECEk11FdCATE HOLDER NAMED TOTIQLEFT. <br />it�)��gii�%Q�i <br />0 Chrinty a2Civic Canter Plaza, ?aG?PL�IX6�{bf�E�Gj€')A�(VG�47#961CX�li»C'35�16�FA E <br />M-21 <br />Santa Ana, CA 92702 <br />AW90f 2Eo REPReSONTATIYE <br />.ioy False/JLF <br />ACORD 25 (2009101) 0 7488-2008 ACORD CORPORATION. All rights reserved. <br />INS025gwwiI The AGURD name and logo are registered marks of ACORD <br />