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CERTIFICATE __._..____ <br /> OF INSURANCE LIBERTY ' i <br /> RECEIVED MUTUAL 'EA,P® <br /> This is to Certify that <br /> ! !7r <br /> LIBERTY MUTUAL INSURANCE COMPANY•LIBERTY MUTUAL ORE INSURANCE COMPANY•BOSTON <br /> PI C 2I �� � <br /> CLE 3t, GE ;f.EE. ooL)t41L <br /> S C A Services, Inc. CITY OF SANTE ANA Name and <br /> Great Western Reclamation Inc. *4XE address of <br /> 1800 So. Grand, Insured. <br /> Santa Ana' California 92705 <br /> is, at the date of this certificate, insured by the Company for the types of insurance and in accordance,With the limits of liability, <br /> exclusions, conditions, and other terms of the policies hereinafter described. This certificate of insurance'neither affirmatively or neg- _ <br /> atively amends, extends or alters the coverage afforded by the policies listed below. <br /> EXPIRATION <br /> TYPE OF POLICY DATE POLICY NUMBER LIMITS OF LIABILITY <br /> COVERAGE AFFORDED UNDER W.C. LIMIT OF LIABILITY-COV, B <br /> LAW OF FOLLOWING.STATE(S)'. <br /> WORKMEN'S <br /> COMPENSATION 1/1/77 tiC1-612-00)+135—o16 Calif. $100,000 <br /> (INDICATE LIMIT FOR EACH STATE) <br /> ®COMPREHENSIVE BODILY INJURY PROPERTY DAMAGE <br /> FORM ), <br /> .J y ❑SCHEDULE FORM $500,000 Single Limit <br /> Q F- <br /> L% $ EACH EACH <br /> w Z Ir',�]]PRODUCTS COM- 1/1/77 (�C`1-612-00141 3 5-02 6 ,' OCCURRENCE $ OCCURRENCE <br /> Z m LeM PLETED OPERATIONS mm <br /> lL Q J ® $Contractual AGGREGATE $ AGGREGATE <br /> Blanket <br /> n ((cBodily Injury and Property Damage Combined) <br /> EACH <br /> ® OWNED <br /> PERSON <br /> O_ ` $m $500,000 Single Limit <br /> 15 m © NON-OWNED 1/1/77 ATI ._00 135_036 Y EACH $ <br /> ACCIDENT EACH <br /> Q © HIRED (Bodily Injury oR and Property }}�, oR <br /> OCCURRENCE D amage CombinedrCCURRENCE <br /> Ce <br /> ui <br /> I <br /> I- <br /> 0 <br /> LOCATION(S) OF OPERATIONS & JOB # (If Applicable) DESCRIPTION OF OPERATIONS: <br /> NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW). <br /> BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER <br /> THE ABOVE POLICIES PRIOR TO DAYS AFTER NOTICE OF <br /> SUCH CANCELLATION OR REDUCTION HAS BEEN MAILED 10 <br /> 1 <br /> City of Santa Ana L 'p�>T20 Civic Center Plaza �''7=) -- <br /> Santa Ana, California 92701 AUTHORIZED REPRESENTATIVE <br /> December 3, 1975 RnatGn MBssaebnaet.ta <br /> l DATEMIL OFFICE <br /> / <br /> This cortil into is executed by LIBERTY MUTUAL INSURANCE COMPANY as respects such insurance as is afforded by That Company,it is executed by LIBERTY MUTUAL FIRE INSURANCE <br /> COMPANY as respects such insurance as Is afforded by Thal Company. <br /> BS 234A R5 <br />