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<br />ACQRD.. CERTIFICA TE OF LIABILITY INSURANCE [ ritl11il'iaOQ
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INfORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE O~RT1I'ICAT~
<br />HOLDER. THLB CERTlFICA. TE DQI!:& NO'J AMI!:ND; EXTBiO Oft
<br />AL TiR THE COVERAGE A.oFORllEo BV THE ~ouCil:$ BiLOW.
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<br />THE POLFGIE8 OF INSUMNCI (,r5TED tJet.OW HAV'f: Bt!EN ISSUED TO THE INSURED NAMED ABOVE' FOR THE POl"ICY PERIOD INotCATED. ~~T\Mjj:fSTA~~~ ANY
<br />REQtRREMeNT. TERM OR CONOITION OF" ANY CONTRACt OR OTHeR lXJCUMENT \MTH RESPECT TO wtilCH THIS ce~TIF'GAIE MAY BE Issueo OR !'MY PEJIl:TAlN....
<br />I :~E~~~SUAANCE AFFORDED BY 'THE POlICtI:~ D~:~~~ ~~~~l~...'S SUBJECT TO" ALL THf! TERMS, EXCLUSIONS ANO CQNDlTl'ONS OF SVCH POLICIES
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<br />I~JlIe.~'!~ TVI'E01= INUil!IIlNCli 'OLIC:"NUN.8U ~M'ff~~ L1MrJ&-
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<br />~ ~ME~CI.6'.GEN!.~MllAeI1.1TY ~ I
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<br />A x I--- ----' CLAIMS MADE @OCCUft SGLI.OO1l84 4/20/2008 (/20/2009 ME t
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<br />X No dculuetibl. l'
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<br />BU:TO~06lLE L1A\lIU'TV
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<br />AN'" AUTO
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<br />ALL O'lli'NED ",UTOS
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<br />\....- 8CHE'CIULf:::O....UTOS
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<br />f- ~IREO AUTOS
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<br />_ NO~'()W!\lm AIft09
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<br />"OOUCE. (626) S~4-3040 FAx: (626)795-4991
<br />Hayward Tilton' Rolapp Ineuranc. Asaoeiates,
<br />Lieen.. to614365
<br />2700 E, Foothill Blvd. STE 302
<br />P..aaena CA Pl107 7100
<br />IN9l.11U!D
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<br />CA
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<br />92504
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<br />INSURERS AFFORDING COVERAGE
<br />1N'&Vf'r:IUl Interstate Fire ,
<br />INsuRu!I;N..tional Union Fire Ina.
<br />II\I.SUAJ;A c_ Lirlcoln Gen.rlll Ins. Co.
<br />I"'SURliiRIJ:
<br />IN8VRe~E.
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<br />NAIC'
<br />22829
<br />32299
<br />33855
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<br />TSJ Electrical , Communieation3
<br />DBA: Masters Electri~
<br />7490 J~~ lWe.
<br />R1vwraide
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<br />Inc.
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<br />APPROVE,) AS TC FORM
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<br />;l~IC~~~~ ~P9
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<br />Assist. i L' "y h no ney
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<br />C.OMB'",,!) 81t'llGLE LIMIT
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<br />"ODll" I~JURV
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<br />BODILY lNJUR'"
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<br />PROPE~Tl OI\MAOli
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<br />AGGRl!r.:nE!
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<br />112595583
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<br />4/20/200~ 4/20/2009
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<br />01DQ.H12'OOn69
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<br />10/18/200e 10/1e/200~
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<br />OEICRr'nOtt OF 0I"l!ftA,"IONStlOC.tlTlOtt51ftHICI.l!'S/Ul.CWSIOJft ADDm I"f f.NDOAIiEMtNTJal'ecIAI. ,."OVISICNR
<br />"o~: C-U,y Qe a-.t. Ma. Ccntcactar Aqh8JI8nt- Dat. 1,Ol{200'8'
<br />C1ty at S~tl Ana, ~t8 off~ce~8. .-plOy".. a~nta, VOlunt..~. and rop~..ent.'~vell art Included ao ~~Lbn61 In_urad.
<br />I.. X'gap.~e. to C8fto:cal Lial:u.l1ty r09.tod1ng opez:aUClftl ?8rfarft8d by 'tho lOUIad 1I1.tIUL&d. p-.: ~ ~ 2G 1& 1;1. &5- "1~
<br />.CMC!iLLft.TJ;W, ll)-~YB NDt.ice ra'r NOtl-PIl~t. ~t: PrQlm,i,wu .ntl/w; Kon-JI,tti'ortlftljJ at Payrol~,
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<br />CERTtFICA'TE HOLDl!R
<br />1('14) ~4~-695'
<br />Clerk of the Ci~ Counc~l
<br />City of Santa Ana
<br />20 Civic Center Plaza-M 30
<br />P.O, Bex 1998
<br />Sanea Ana, CA 92702-1988
<br />
<br />CANCELlATION
<br />11I01Il.00 ANV O. THE. AIOVli IgElCQ.8U1 POI.ICIS.. .e l;ANt:l'l.l.ID SE~AIl "HE
<br />liiiX'IRAnOH DATIS THERMf!', TIi~ I.I.IUl"lO INltllIP: .,.,..l rM:lU,V(l1Il TO MAIL
<br />~ ~.Y! WRlrnN NO'nC:E TD THI C;ElIll1~T& HOLDIl. NAMED TO fttll.fFT, BUT
<br />F...tlUR~ TO DO '50 SMALl-IMPOSt: NO OBLJGlto'n()p.l OR llAIIILr1V OF IoN'( .UNO UI"ON TIll"
<br />lt4SURl!A 11'1 AOEN'fI.OR "'P"E81!."".T1Vf'"
<br />AU1WOMZEO HfIIItfIlNTIlTIft
<br />S~ndra Marroquin/SAM ~ b--Q'......JfI!I,. ,....., ~rroO--,
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<br />'CORD 2512001/08)
<br />NSD251DttlelOllo
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