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DESMO-1 _OPID: AM
<br />CERTIFICATEOF LIABILITY INSURANCE PATE(MMlDD Y l
<br />11fQ672019
<br />THIS CERTIFOATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS _
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT! If the certificate holder is an ADDITIONAL INSURED, the polisy(les) must he endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PROOUCCR -
<br />CONTACT
<br />Stoves L. Monteith
<br />John J. Matsock & Assoc. Inc,
<br />1750 N Washington Street
<br />_yA�LHSI _,,, _
<br />aCNNo E e 83tl 55-7850 _ _ 1No Not .. _._.
<br />Naperville; IL 60663
<br />a aal=ss
<br />Steven L. Monteith
<br />LIABILITY
<br />{NbURE,R(SL74FfCRi?iNO GtIVfrRAGE NAC.9
<br />EACH OCCURRENCE
<br />INsuRERA.StPauiTtavelees-AMD 25674
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<br />tNSURER a:
<br />OUttCABeverly Glen BIYd,
<br />68G1B71660G T2t4172,013
<br />Los Angell ess,, CA 96024
<br />INSURER C;
<br />5
<br />300,40
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<br />INSURERD:
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<br />INSURERE:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEfRIODw
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />'TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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<br />LIR 1'YPR OF M611RANDE ` POLICY NUMBER PoM10D Y rN,N,{{SbIYYYY
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<br />EACH OCCURRENCE
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<br />1 404 04
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<br />164004
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<br />DESCRIPTION 4P OPERATIONS LOCq'PION3 / VEn@LES (Attach AC,ORO 1Vi, AJUIemlal Rm'uerks Sch90nio, If more apaua IdtequlrNUi
<br />ADDITIONAL INCURPI) WITH RESPECTS TO GENERAL LIABILITY: CITY OF
<br />SANTA ANNA,I'TB OFFICERS, EMPLOYEES, AGENTS, VOLUTFIR�S AND
<br />Rb1PRESRNTh'TILVES//ADDITIONAL INSURED IS PRIPUPSY AND NON
<br />CONTRIBUTORY//AS REQUIRED BY WRITTEN CONTRACT, CERTIFICATES
<br />ARE SUBJNSCT TO ALL 'PO'LICY TERMS AND CONDITIONS,
<br />SANTAAN
<br />CITY OF SANTA ANA
<br />PUBLIC WORKS AGENCY
<br />ATTN: JASON GABRIEL
<br />20 CIVIC CENTER PLAZA M-36
<br />SANTA ANNA, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED ROUGHER BE CANCELLED BFPORE
<br />THE EXPIRATION NATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />rrilana�nalnncnlznenRcnaarinN. auHfiH+RrM.:«.rgr,rl
<br />ACORD 25 (20 10Y05) The ACORD films and logo are regiso.red marl of ACORO
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