Laserfiche WebLink
Jun 24 09 09:36a <br />P.1 <br />CERTIFICATE OF INSURANCE <br />'811JOH INSC1RANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE <br />'1 *11111CMIED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRn-nFN NOTICE TO THE <br />CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM <br />THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY <br />ANY POLICY DESCRIBED BELLOW. <br />This certifies that ® STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois <br />? STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois <br />? STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas <br />? STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or <br />? STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois <br />has coverage in force for the following Named Insured as shown below: <br />NAMED INSURED: COAST SURVEYING, INC. <br />ADDRESS OF NAMED INSUREQ: 15031 2ARKWRY LOOP, SUITE D, TOS~IN, CA 92780 <br />POLICY NUMBER 059 5449-DI9-758 C:90 5581-FIC-75G <br />EFFECTIVE DATE <br />OF POLICY 02/15/09-09/15/09 02/15/09--08/15/09 <br />DESCRIPTION OF 1999 DODGE 1989 JEEP <br /> <br />VEHICLE (kxwing vim) G0 <br />1R4R&?. <br />R4RRBY.BXN 6D5997 <br />CHBRQREE c <br />1J4PJ78I,1KL5.,5564 <br />LIABILITY COVERAGE ® YES ? NO M YES ? NO ? YES ? NO ? YES ? NO <br />LIMITS OF LIABILITY <br />a Bodily Injury <br />Each Person 11000,000 1,000.000 <br />Each Accident 1, C00, 000 11000,000 <br />b. Property Dan-age <br />Each Accident 11C001000 110001000 <br />c. Bodiy Injury TL <br />Dama <br />e <br />Pro <br />ert <br />g <br />p <br />y <br />Single Limit <br />Each Accident <br />PHYSICAL DAMAGE <br />COVERAGES <br />® YES ? NO <br />® YES <br />? NO <br />? YES <br />? NO <br />? YES <br />? NO <br />a. Can naive $ 1000 Dedudk ie $ 1000 DeA rdible $ Deductn* ?? Deduc" <br /> ® YES ? NO ER YES _ ? NO ? YES ? NO [I YES C] NO <br />b. Collision 3 1000 Dedocfte $ 1000 Deductible $ DeduclIft $ DedwAble <br />EMPLOYERS ® YES ? NO <br />- ® YES ? NO ? YES ? NO ? YES ? NO <br />HMED CAR <br />COOVERAGEI TABU 17Y <br />® YES <br />? NO <br />® YES <br />? NO <br />? YES <br />? NO <br />? YES <br />? NO <br />FLEET - COVUtAGE FOR + <br />MOTOR ?vo? s I ? YES CK NO ? YES ONO ? YES ? NO ? YES ? NO <br />AGENT 8126 06/24/09 <br />Title Agents C we timber De4 <br />ADDITIONAL INSD: CITY OF SANTA ANA <br />P.O. BOX 1989, SANTA ANA, CA 92702 DESCRIPTION <br />OF OPERAZIONS:RE:AI,L OPERATIONS AS PERTAIVS TO <br />NAMED INSURED. THE CITY OF S..MTA ANA, ITS <br />OFFICERS. EMPLOYEES, AGENTS,VOLUNT£ERS AND <br />REPRESENTATIVES ARE ADDITIONAL INSURED AS <br />RESPLC73 TC GENERAL LIABILITY AS REQUIR3D BY <br />WRITTEN CONTRACT COVF:RAGF. AFFORDED THE <br />ADDITIONAL INSURED IS PRIMARY S PKM CONTRIBU- <br />TORY.WAIVER OF SUBROGATION INCLUDED IN WORK <br />SIJ1t? 14tH TED - X. AgW <br />License #D492135. <br />3 4085 Pacific COast HWY.. Ste. 204 <br />L na PoK CA 92M <br />Bus: (949)661-32W <br />Far, (949) 661-4119 <br />GIB Attorney. <br />siatant City <br />>j,