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le <br /> CERTIFICATE //' r <br /> OF INSURANCE LIBERTY Ea--41 <br /> 11_ <br /> R c co MUTUAL _ ,tl. <br /> a <br /> mk$/J LIBERTY MUTUAL INSURANCE COMPANY•LI BERT MUTUAL SEE!INSURANCE COMPANY a BOSTON <br /> This is to Certify that <br /> SCA Services, Inc. 4tK �t 'y3C: a A A'L Name and 'IA. ('t4�. � <br /> Great Western Reclamation C E C'( OF SM - 4-ox address of v <br /> 1800 S. Grand Ave. Insured. �� I�' <br /> LSanta Ana, California 92705 .J <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 terns 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 WC1-612-001+135-016 Calif° $100,000 <br /> (INDICATE LIMIT FOR EACH STATE) <br /> ®COMPREHENSIVE _ `, BODILY INJURY PROPERTY DAMAGE <br /> FORM <br /> CI d <br /> - I ›- SCHEDULE FORM / $500,000 Single Limit <br /> EACH EACH <br /> w� ®PRODUCTS COM- 1/1/77 LG1-612-001t1-35-026 EACH <br /> EACH Z ra PLETED OPERATIONS <br /> W Q <br /> U_Ti ® Contractual $ AGGREGATE $ AGGREGATE <br /> 1 I = (Bodily Injury and Property Damage Combined) <br /> r— OWNED $ EACH <br /> PERSON <br /> O I-� $500,000 Single Limit <br /> ��F— �r NON-OWNED 1/1/77 AE1-612-00({•105-036 $ EACH $ <br /> ACCIDENT ACCIDENT <br /> <Q (Bodily Injury oR and Property OR <br /> J O HIRED OCCURRENCE <br /> Damage Combined RRENCE <br /> 1 <br /> W <br /> I <br /> O <br /> LOCATION(S) OF OPERATIONS 5 JOB # (II 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 SUCH CANCELLATION OR REDUCTION HAS BEEN MAILED TO <br /> r City of Santa Ana 1 <br /> 20 Civic Center Plaza t.<...c,F—et_J 6 I d "2...„&,.-0 <br /> / Santa Ana, California 92701 AUTHORIZED REPRESENTATIVE <br /> November 28, 1975 Boston, Mss elms Aft$r <br /> L DATED OFFICE <br /> i MM <br /> This certificate is executed by LIBERTY MUTUAL INSURANCE COMPANY as respects such Insurance as is°Horded by That Company,it is executed by LIBERTY MUTUAL FIRE INSURANCE <br /> COMPANY as respects such insurance as is afforded by That Company, <br /> BS 234A R5 <br />