.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 />
|