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.vc "Ic N , > > onre(MaloDYC ETFICArz OF LIA R I ITY DNS f RANGI . yl <br />11!13/2014 <br />THIS CERTIFICATE IS iSSt7r U AS A MATTER OF ►NFORNfATION DNLY AND CONFERS. NO RIGHTS U}�ON tliE CERTIIGATE HOLDER, THIS <br />CERTIFICATE DOES NO7 Al FIRi41AilVELY OR NEGA71VEty 'AMEND, ii: NO 0. !L TER Tti9a C0VEt2AGE AF'P­ 4RREp BY THE 0, (CIE$ <br />BELOW. THIS CERTIFICATE OF' INWRANCE; DOES NOT GOWTTTUTE' A CONTRACT BETWEEN THE- 13S�UINO INSURE R($), AOy- Ot2t Eb <br />REPRE$I NTATfVE OR P ROCIUCER, AND T'I CEf271FICATE HOI DER: <br />iMPpRTANT; If th> Gortif3oafp holder Is an Apl]iTIQNAI ,IN$UREt , ttte pg tcji(les) ntyst be eildprsRd, 1f SUBROGATION :IS WAIS/ED, subject to <br />the terms and conditions pftho P011.0 , certain Polloles_may require an endorsement. A statement on this certffieats does not confer rights to the <br />GOrtiflcare Balder In lleu of.'sueh endnrsemont(s), <br />rfzasucER 'CO Tn Mike S Brandon <br />Mike S. Brendan P1% 'Y'T 9Q9 794 tS191 <br />9 909- 794 -Q193 ' <br />Insurance Agengy noo less, rnbrandon @farrnotsagrint:com <br />31629 Outer Flwy 10.S, OA <br />IN$URER S AFFOROMq CGW!RA NAICN <br />Redlands :Ca. 92373 Ataln Special Insurance C6, <br />. •..• -• INSURER A � 80619Y Insurance <br />inspnae INstlReRS: <br />Formers: insutagctl <br />iWd #er; lria" - <br />1N8URER.G.: <br />16 GoodyearSfa, 100 <br />INSURCrR:IX.r_ <br />Irvino, 00, W618 — ---- _ • .......... <br />MsURER e'; <br />THIS 19 TOETERTIFY iIV 7K POLICI$S,OF INSURANCE 11'STED WELVVJ HAVE.aEEN- ISStJEq'1'O THE <br />INSUREU'NAMEp At30V.E POR THE;FOLICY PERIOD <br />INDICATED. NOTWI "TH5TANpINCr ANY fZEQUIFtEMENi n ERM:pR GONDI ?ION OF.ANY CONTRACT OR`Q'THER bt7CUMENT'tNITH RESPECT TO WHICH THIS <br />CERTIHQATE'MAY't #E 1SSUECI Oh MAV f?ERTAIN; THE INSURANCE A FOROEQ.. BY THE PfJt iCIES <br />-PE HEREIN IS SUBJECT TO <br />EXCLU$1bNS AND CONDiTibNS OF SUCH,POLi' 0. LIMIT$ SHOWN MAY HAVE~ BEEN•R8 .Li SY S, -PE AIMS. <br />AU THE 'PERM$, <br />.LTR TYPEOF.IN$UnARGE - .POLICY' FF <br />POLICY NUMBpR M1/D <br />pL'I,GYG R•- .. <br />M,�DpD yyY Limm <br />CdMM$MALGENN.hALI;IAe1LITY" <br />..: <br />cLArMs MArjC riCCUn <br />EApH OCoURRLyGE <br />Am ftdN#CS- <br />s 1 QQO 000 <br />- <br />IS : Euaccu' onLd <br />S 10Q;S00 <br />-_.�__ <br />A X Cll'22421:2 10/27/2014 <br />MEO'GXP�fnY- o�q.PCsoh) <br />:10!27/20:15 PERSONALx Apv MJURY <br />$ 5,000: <br />$ 1,000 Q00 <br />GENLAGGREGAYRLIMrrAPPLIES :PER; <br />`� PRb. <br />.POLICY L:,_J JE4T �. Lbd <br />- G•�ENFRALAGORCGA7F. <br />— <br />$ 2,Q00 000 <br />flign1 CTS •.00I PIIX �A.' <br />$ - 2,000,00(1 <br />II <br />_T <br />$ <br />AUTOIA(MILE <br />" <br />— <br />41011. TY' <br />�ANItY,ALttU <br />"" <br />COMSINED- SINGLE LIMIT <br />�(EanCC(dahl 1 <br />3 1;000000" <br />OOUILYINJURY(Pwparson) <br />_ <br />$ — <br />B' <br />- • <br />/v � <br />�u70G NFO <br />tIIREt)AUTfS,S Asnp NuTObSU. LCO. <br />UDoWNo <br />60.5E8 1543 t i <br />2 <br />/ '0( <br />Y DIL lAPCa.rff a ccldn 0 <br />Q4PTd''JfnUh <br />_,,..,�•'-..—.....- <br />..S - <br />rCxR idMX <br />ppttAI M <br />�. . <br />EACkIOCCURRENCC <br />y . <br />ILL � <br />UMBRELLA LIAb OCCUR <br />EC <br />.. <br />s$ LAe A <br />AG.GREGAY[4: _ <br />,$ <br />DE6 REMNTlb $ <br />$ <br />WORI(ERS:COMPENSA1pN <br />AND 5WPL0YE40 UAOILITY YIN <br />ANY PI'dbPRICToNpArtY.NCR)EXCOUTIVE <br />_ <br />_-_, vYAI U'�E._ " Ett <br />'" " " "' <br />'' "• ^•• '.­­' <br />Of FICERIMEMDEq EXCLUDMI? <br />-NIA <br />E.L EACH ACCIDENT <br />$_`� <br />Wp'ndnlorp, 4,.N1i1 <br />it yyes dtis101W nde"r <br />D[S IN.TION OF OPPRATIONSbb- <br />414 DIsPASE.EA.EMPLOYE ] <br />__ <br />E :l. W.EASE- :POLICY LINI.T <br />$' <br />.. , ... :. .. <br />DtCS`RIPTION Or OFERATIDNS I LOCATIONS t VPIIGLE9 (ARORD'101,Addl`tlontil Romorha 3011ed(90,m5y'be'atlaahod It more opr,,ca is rogdirad) <br />- <br />Ad.011lonai Insured: City of Santa Ana <br />iWATER, INC: AGREEMENT # 4 -201 -053 <br />REVIEWED BY:� °' EUNICE HEREDIA <br />(PG. 1 of 4) <br />SHOV,LD ANY OF THE ABOVE DE$COED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION ••pAT TH11REOF, NOTICE WILL BE "DELIVERED IN <br />City of Santa Ana ACGORbANCE Wt7H ii '000 PROVISIONS, <br />20 Givlc Center'PI a <br />AU 6M D REPq r NTATIVE <br />Goss Annex (M-1). 1. <br />Santa Ana, Ca. 92701 4068 <br />O 158d:2t)14 AGCiI21 CORpiFtAiION. All rights reserved, <br />-.. _._ _• ,..,., ..,,....,�..,,... .., ,,�„ „� n„�;.tvyN Ktr.v I w*tOrw marKS Or; AGUML) <br />