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P'f"MANCE COMPANY OF NORTH AM°"' ' .. ' ',,,�,ia' <br /> AND U t� Q <br /> ' PACIFIC EMPLOYERS GROUP'OF INSURANCE COMPANIES /e L'' <br /> CERTIFICATE OF, INSURANCE <br /> • (This Certificate of Insurance neither affirmatively nor negatively amends, extends <br /> or alters the coverage, limits, terms or conditions of the policies it certificates.) <br /> 1Eltis is to Teddy to • <br /> COMPANY CODES <br /> City of Santa Alla ® ALLIED INSURANCE CO. <br /> 20 Civic Center Plaza • © PACIFIC EMPLOYERS INDEMNITY CO. <br /> Santa Ana, California 92701Ej <br /> PACIFIC EMPLOYERS INSURANCE CO. <br /> L J w INSURANCE COMPANY <br /> OF NORTH AMERICA <br /> that the following described policy or policies, issued by The Company as coded below, providing insurance only for - <br /> hazards checked by `X'' below, have been issued to: <br /> Name and Address SCA Services, Inc. & Wholly .Owned Subsidiaries Including <br /> of Insured— Great Western Reclamation, 1800 S. Grand Ave. , Santa Ana, California 92705 <br /> covering in accordance with the terms thereof, at$ XYIXia1Fty7Gocation(s): <br /> all <br /> TYPE OF POLICY HAZARDS CO.CODE POLICY HOMIER POLICY PERIOD LIMITS OF LIAIILITY <br /> (a) Standard Workmen's <br /> Compensation & ® 9[] SCF 40 10 30 1/1/75-76 Accidentry W. C. <br /> Employers' Liability i 100,Q00. One Aggregate and <br /> r. _ Disease <br /> (b) General Liability t ` v <br /> Premises—Operations (including "In- ® ® P' <br /> cidental Contracts" as defined below) $ Each Person <br /> GLP 45 6963 11/14/74 <br /> Elevators ® 0 t0 f Each )5❑ Accident <br /> r Independent Contractors ® ® / 1/1/76 a 1❑ Occurrence <br /> a° Completed Operations/Products X 9 JSOQ Q00. Combined Single <br /> a 0 '/ s Limit <br /> Contractual, (Specific type as de- `/ .. $ Aggregate—Completed <br /> scribed in footnote below) a a r __ _ _, _ Operations/Products <br /> Premises - Operations, (Including S❑ Accident <br /> a "Incidental Contracts" as defined ® a $ Each 1❑ <br /> below) Occurrence <br /> Elevators ® ® ,GLP 45 69 63 11/14/74 $500,000. CSL <br /> t0 $ Aggregate—Prem./Oper. <br /> Independent Contractors a � 1/1/76 $ Aggregate—Protective <br /> 2 Completed Operations/Products ® Di $ Aggregate—Completed <br /> 0. <br /> Contractual, (Specific type as de- <br /> Operations/Products <br /> scribed in footnote below) g ® l $ Aggregate—Contractual <br /> (e) Automobile Liability w 11/14/74 ] $ Each Person <br /> Owned Automobiles ® ® CAL 12 06 88 to ll $500 000. CSL <br /> Apr s ❑ Accident <br /> 9? Hired Automobiles <br /> E � <br /> t __ Non-awned Automobiles , _ 1=1 i/l/76 _ 4 $ -- — Each ❑ Occurrence - <br /> ry Owned Automobiles ® ® 11/14/74 5❑ Accident <br /> a'E Hired Automobiles Q El CAL 12 06 88 to lli $ <br /> Each )0 Occurrence <br /> ° Non-owned Automobiles ® 1/1/76 $500,000. CSL <br /> (d) <br /> • <br /> Contractual Footnote: Subject to all the policy terms applicable, specific contractual liability coverage is provided as respects 0 a contract / 0 purchase <br /> order agreements / IC all contracts (check applicable blocks) between the Insured and: <br /> Nameof Other Party: - —._— <br /> Dated (if applicable):___ _—._ -- Contract No. (if any): <br /> Description (or Job):__ _ - __. _ �.—. ____ <br /> Definitions: "Incidental contract" means any written (I) lease of premises (2) easement agreement, except in connection with construction or demolition <br /> operations on or adjacent to a railroad, (3) undertaking to indemnify a municipality required by municipal ordinanc., except in connection <br /> with work for the municipality, t4) sidetrack agreement, or (5) elevator maintenance agreement. <br /> It is the intention of the company that in the event of cancelation of the f OH ON & HIGGINS OF MASSACHUSETTS, INC. <br /> policy or policies by the company, ten (10) days' written notice of such • <br /> cancelation will be given to you at the address stated above. Authorized Representative <br /> LC--138 9a 1-7/ PRINTED IN U.S.A. SY' `�' "'e'• r'�''f"� A I-f'O RN�Y <br />