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Samule Certificate of Liability Form <br />.acQ�p_ CERTIFICATI= OF LIABILITY <br />INSl1RANCl =: °"�" ""'°°""' <br />11/12/97 <br />vwvuucER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF IHFORlAATION <br />ONLY AND GOSY> =ERB NO RIGMTS UPON 7HE CERTIiiCATE <br />Insurance Ssrvices Group, ine _ <br />2Da Codas 3trQat <br />MOLDER. TFIIS CERTIFSGATE ODES NOT AMEND, E %TEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />COMPANGES AFFORDING COVERAGE <br />Cambridge ?ID 21613 <br />��'�!"� <br />A F"adaral Inavraxc® Company <br />G_ Philip Fe ldanan <br />PAwa�Rn. CYO - 226 -¢. 464..__.._ EAx .Ho,�__- ____..--- __.___._..__.. .,.— <br />____. <br />COVPArf.' <br />w SUwCO <br />B <br />ppwwNY <br />C <br />CDYAANY <br />b <br />COVERAGES., - -. <br />__,... _ <br />THIS 6 TO LERTai1f THAT THE POalC1E5 QP INSURANCE LLSTED BELOW WIVE SEEN ISf.RILD TO THE 1lCSlAREb ALNr1E0 ABdu! POR THE POLOCY FJC.92100 <br />aIDICATED. NOTWITNSTAMONiO AUIY REQI.rtEMCNT, TERM OR OONCff10N OP AJ!'/ OONTRACT OR OTHER DOGUTAGN7 WlTM RESPECT TO YNHICN TPYY.^. <br />GERTIPOGQTE. AMY BE � W ED OR G.NY PERTAIN. THE INSURANCE AFPipR9ED @T THE POLICIES DESC'RIBEO MEREIN IS SUDJEG7 TO ALi THE TERMS. <br />EioGLVaIO.NS AMO COHOD'ID1JS OF St1d1 POLICIES. LlIN1T'S SF10\VT.I A4AY WIVE BEEN REDUCED BY PAID CLMwL_ <br />CTR <br />TYPE OP p1iLMMICB <br />POLK:Y NYr99R <br />POL]CY EFI7:C1lVE <br />OATB pwrmwYYl <br />P'OLJCY EXPYIATION <br />GATE 1wMVOG^/Y7 <br />llnVfrS <br />oC..cawc <br />LWa61TT <br />GENERAL ARGREAATE <br />i 2 , 999 � 99D <br />pROpUCTS•ODMPpp AC6 <br />i2 000,000 <br />A <br />X <br />COaMERCJAL C�JlER�AL L�IAaLT' <br />00/01/97 <br />OC /O1 %9B <br />LlJY119 MADE L ^J °GI'T� <br />PERaSNALAAby NRIRY <br />S1 000 99D <br />owNErrs • eDUrRACrioh'a F1eOT <br />EACH OceuwNaAtE <br />s 1 600 000 <br />sTREwserae /A+IreM r..I <br />_ <br />s Included <br />MED Dm IwwT «�. Palscwl <br />s 10 O'1 O <br />,wroNOeILE <br />uwaaRY <br />caw®s�m RMdOLS IRwT <br />s 1 , 0 QO , 000 <br />hNY MIrO <br />I <br />P�LP°'aO1i Y <br />_ <br />T <br />_ <br />aL.L rywnBp wtros <br />36�a/1.E0 KVTOS <br />B�a�.�uhy <br />Gp����,0 <br />s <br />A <br />X <br />{ X <br />MREO AU-ros <br />NONOf/NED AVTGS <br />06/01/97 <br />04/01/98 <br />AROPER'TY OwMAGE <br />i <br />-- <br />.iii <br />GARAAE LIAawJIY <br />_ <br />ACCIDENT <br />i <br />�VTOO'+LY�EA <br />OTKh Tllw Artalo pPw,T: <br />M1x/ MITO <br />EAUiACGOENf <br />i <br />� AGGREGATE <br />s <br />{ oocczs L4aa�ITY <br />9 <br />EwcN OOOUwslm.ew <br />z <br />AD6REOA`IE - <br />3 <br />uMEi1BV.FORM <br />� <br />� <br />1 <br />OTTER TMA!l VMERELIA igwM <br />� <br />YIORIiERb CVMP@ISiTlpAl PMU <br />YMPLOT V[s aIAOILT =Y <br />` <br />I <br />� TDRT LRIIrB <br />FA EAr..N wpppENr <br />■ <br />IHE rRGPrzFDRi N4 <br />P'AhTPIEM3EIlECLRIYE <br />Ee DmrEwss- POalri awnT� <br />s _.- <br />EV_oe9EA& = -£i. r�ilxayCe <br />- -. <br />s <br />alrslDeRS ARE � <br />amen <br />DESCRVTww oP GPEwar.oNSnocnTloNS . vE1scLESlmreclAi ITOws <br />CERTIFICATE MOLDER .. -. _ - , . .. CANCELUlT10N .. <br />wWOYLO ANY oP TM6 a9WE iy6iCR�QO POIIGEB 6E CA.iICElL® wEi'dwE THE <br />CITY OP SA.�fTA ANrL. ITS Oi'F7CERS_ AGET TS rIND E+inRATwNGaTe TNnReor. TNrlwawNO COVwrTwlu owrwwwr 'reaaAia <br />39 WYE YVIITrEN NOTICE TO THEI�RTw'ICJITG NCi001 NANW TD TNEI�T, <br />EMPLOYEES <br />P.O. BOS 197245 <br />SANTA .4NA. CA 927112 - <br />aVlMpwgpO wiYwyy(JITATWE <br />�,P� t 'Ole xo._..,. <br />G. Hhilip Feldmax � <br />AGORD 26 a i1fY6T .. .. �' :':' :: -. - ', ' .: -r_ - f >: .. OACORU "CORPOGiAT7OV1 7989 <br />47 <br />