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CERTIFICATE OF LIABILITY INSURANCE
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<br />THIS CURTIFIOATR IA 1001100 AS A MATTER pis INIsORMATION ONLY AND OONPORS NO RIONTO UPON TH4 OORTIPIOATO HOI.OrR. THIS
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<br />RUPPI IitgNTAWN OR PRODl1OHR, AND 7119 CRRTIPIUATO NOWLIN,
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<br />It SUBROGA11ON IS WAIVRD, auhjoot to On forma and ookidltlona of Iho pol�ay, Oorlaln pollolop may varyulro nn ondorsament, A atalomant on
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<br />THIS IS TO CERTIPY THAW THR POU0108 pis INSURANCE LISTRD 04LOW HAW UQRN W1000 TO THE INSURED NAMED ABOVE FAR THE POLIOY KniOD
<br />INOICATI10, NOW0114TANOINO ANY RCQUIROMCNT, TERM OR CONDITION OF ANY OONTRAOT OR OTHOR 000UMONT 11YITH RicsPJCOT TO WHICH 'CHI&
<br />COATINOATO MAY BE IOSULsd OR MAY PERTAIN, TIIR INSURANCE AP6ORDSO BY 711H W10145 DSSCRMED HEROIN IS SU04OT TO ALL THR TrIRMA,
<br />OXCLUSIONsAND CONDITIONS OI:SUGH POLICIES, WiT3 611OWN MAY ffAVI!OREN AUDUORD DY PAID OLAIMs,
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<br />riot "Damolltion Services an an bn-Call basis RIM 22-001" OVaratlons of tho Naatad 10ourod. City of Banta Ann, ,its
<br />nomad as Additional xneured. litX" aAgeri by written
<br />affious, offi0la.lo, amployeee, and volunteers are hornIn,
<br />nt:r eoaoL, per enctoraomonL• hereto, waiver of SubrophLon n, hrovidedt es toqulred by wrlttan contrnat with the inoalted
<br />as reapaoto aoverago ovidoncod haroln. Covarago ovictonaed herein is Prllaslwy and non-aontributoa r MUO le fal]lola
<br />form to the uudorlyinq ctonarol. a.labll.ity, Colameralal Auto and Worhera Compansatlon Covoroiao, A 30-day written notloa
<br />shall be mailed to the eortlftooto holder at the addraso provided heroin, ahaald a douotiued golioy(p) be annaoil.od
<br />hetora tho aRpLrcation dato tharaofJ 10-•day notice for non-payment of promi,um,
<br />11oldoes Wore of1wenlht: AWI(Ionol IIIlured
<br />My Df$anln Aga
<br />20 Civla Conley IOWA M•30
<br />Santa Ann, CA 92702
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<br />THR axFinaaN DATR WRRUOP, NOTION WiLL tiH DRIL VGRHD in
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<br />ACIORD 29 (2010103) 1110 ACORD namo nW loan tiro roplotorod manta of ACORD
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