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<br />,
<br />
<br />From:Ellen Begun
<br />.
<br />
<br />FaxID:516-466-4213
<br />
<br />Date:12/17/2008 11:26 AM Page: 1 of 1
<br />
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 EB I DATE (MMlDDIVYVY)
<br />CONSO-2 12/17/08
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Butwin Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />Sui te 414 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />60 cutter Mill Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Great Neck NY 11021-3104
<br />Fhone:516-466-4200 Fax:516-466-4213 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED INSURER A lIaUonlll l1nion riu In_. Co.
<br /> United Testing Co~oration
<br /> dba United Inspect10n 'NSLRC;;'3 AIG
<br /> and Testing INSURERC Houston Casualty Co. --
<br /> 22620 Goldencreest Drive
<br /> Suite 114 -. .-
<br /> MOreno Valley CA 92553 II\SU~EF 0
<br /> i I~.ISJRER E I
<br />
<br />COVERAGES
<br />
<br />T>-JF pr, 11.1[:; CJF Ir'15JRMCE LISTEl' ::lELUVV I-.AV:::: 'iEEt>. ISSUE) TO TrE IMill;;>ED hlAMED ABOVE F:..:R THE POLICY PCRI,)D INm :ATi'-O t\07VI/ITHSTAN[llr'~G
<br />ANY Ri::OLlREMcNT, TERM OR '~t,;r"DIT O"l::::F NJT CONTRACT OR OThE>< DOCl'MI:N WITt-: RE::;::>tCT TC W...JICH THIS CERTII-ICATE MA.Y BE ISSUED')R
<br />MAV PE::.>IA N T-iE I'EURANCE AFF'1RCEl' ey ft,E PCll(Ii:S 0::3(.:;>18ED HEREIN IS SUBJE.CT TO ALL TrE: TERMS ::)(C~'JSIONS AND CONDITIONS i)F Sllel-
<br />F'A "~IES. AG'~REt~A11:: L Mi "Sl-<OW'~ \1AY HAVE B::EN F<EDLCED By PA.ID ':..AIMS
<br />
<br />LTR NSR
<br />
<br />P
<br />DATE (MMIOOM')
<br />
<br />LIMITS
<br />
<br />"
<br />DATE (MMfDDIYY)
<br />
<br />POLICY NUMBER
<br />
<br />TYPE OF INSURANCE
<br />GENERAL LIABILITY
<br />[MMERL~ Al -,"NEf,:AL LI(\BILI~)
<br />nAM"'M^CE ~ "~IJR
<br />
<br />
<br />h[I\LN,'R: fir
<br />F")LI:::' _:x
<br />
<br />A
<br />
<br />07/01/09
<br />
<br />EACH l)CCURFE~KE S 1,000,000
<br />FREMISE", :Ea "(~~,r~llce) $ 500,000
<br />MF:iE;(P(^nyuner'~r,un,1 $10,000
<br />PE%)I'JAL i'. ADV 1t\,IUI'{Y $ 1 , 000 , 000
<br />GE~IERAL AGGREr,AJE ~ 2 , 000 , 000
<br />~Rr)::;IWTS. COMP/OP A.:::<; 1$ 2,000,000_
<br />
<br />4022676
<br />
<br />07/01/08
<br />
<br />
<br />
<br />$1,000,000
<br />
<br />A
<br />
<br />AUTOMOBILE LIABILITY
<br />X A~IY A.lfLj
<br />ALL O'NI~'::D AUT8S
<br />
<br />3853974
<br />
<br />':8M3INFDSIt\'-,LELIMT
<br />lEa accij~..r.)
<br />
<br />S.-:HEOULEC) AUTOS
<br />
<br />HIh.'_L,A!WiS
<br />
<br />'~r)~j 'J\:vN!:.L' AI iT'
<br />
<br />GARAGE LIABILITY
<br />
<br /> AUT(':J~jLY 'OAACC::IDENT
<br /> ,-,THER ThA~j 9'. ACe
<br /> A,UTCONLY AGG ,
<br /> EACH 00 :URRI::NCE $ 4 ,0,00 ,000
<br /> -.---.-
<br />07/01/08 07/01/09 ';:3GREGATE I.~ 4,000,000
<br /> I
<br /> '" ---
<br />07/01/08 07/01/09 E L EACHACCIO::N":" , 1000000
<br /> EL DlS~SE-E:AEMP~:JYEE I 1000000
<br /> E.L DISEASI:: - FOLIC', LIMIT , 1000000
<br />
<br />!...t-J'iAIWi
<br />
<br />B
<br />
<br />EXCESSIUMBRELLA LIABILITY
<br />)!J' ~U'f _J j',IMS ~/ADE
<br />
<br />b::'ESUCT8LE
<br />X REmmOt, $10000
<br />i WORKERS COMPENSATlDN AND
<br />EMPLOYERS' LIABILITY
<br />M\Ph,:,PRI~":;>r'll..RT1.ERfE)(EC:jTI\lE
<br />')FFICE'f/\tEM8.-r E\rLUDE[l}
<br />I Y~5 ~~'."r D" undn
<br />>'PE..IAL PRC;VI:;I<lt,.:S l'~low
<br />OTHER
<br />
<br />WC7578176
<br />
<br />BI!:3128610
<br />
<br />
<br />B
<br />
<br />C PrOfessional Liab
<br />Retro Date 9/1/85
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />City of Santa Ana Corporate Yard, 202 South center Street, Santa
<br />92702, job statinq 3/28/08
<br />
<br />H 707-15549
<br />
<br />10/01/08
<br />
<br />10/01/09
<br />
<br />Ea Claim
<br />Aqqreqate
<br />
<br />1,000,000
<br />2,000,000
<br />
<br />Ana, CA
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CANCELLATION
<br />
<br /> CrTYSAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
<br /> -
<br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
<br />City of Santa Ana IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />F.O. Box 19BB, M-22 REPRESENTATIVES.
<br />Santa Ana CA 92702 AU~ REPRESENTATIVE
<br />
<br />ACORD 25(2001108)
<br />
<br />@ACOROCORPORATION1988
<br />
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