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cj <br /> EMPLOYERS-COMMERCIAL UNION COMPANIES <br /> IIV BOSTON,MASSACHUSETT <br /> DENVER, COLORADO <br /> THE MAN <br /> WITH THE PLAN® (Name of Insurance Company) <br /> CERTIFICATE OF INSURANCE Date 5/26/72 <br /> Zf)iS ii to CBCtitp that the Company named above has issued a policy or policies, covering in accordance with the <br /> terms thereof, to the insured named below. It is the intention of the Company that in the event of cancellation of the <br /> policy or policies by the Company during the periods of coverage as stated herein, TEN days written notice of such <br /> cancellation will be mailed to the party to whom this Certificate is issued, at the address stated below, This Certificate <br /> of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by the policy or pol- <br /> icies issued by the Company as indicated above. <br /> Name And Address Of Party To Whom This Certificate Is Issued Name And Address Of Insured <br /> CITY OF SANTA ANA GREAT WESTERN RECLAMATION INC, <br /> CITY HALL Blackman & Blackman, a partnersh:.p <br /> 126 East Byer Road <br /> SANTA ANA, CALIFORNIA Att: Mrs V1'est Santa Ana , California <br /> Description of Motor Vehicle <br /> or Operations of Insured <br /> Place of Garaging or <br /> Location of Operations or Premises <br /> TYPE OF POLICY X* POLICY NUJBERt POLICY PERIOD LIMITS OF LIABILITY <br /> STANDARD WORKMEN'S COMPENSATION EFFECTIVE <` EXPIRATION <br /> & STATUTORY <br /> EMPLOYERS' LIABILITY "` \` -� $ Coverage B <br /> GENERAL LIABILITY 4..,,,/ ` <br /> BODILY INJURY ° J <br /> Premises Operations x EC 4002311 4/9/72 �Y 4/9/7 ¢ � $ 250,000 Each Person <br /> Elevators ((�-T�,` _)" `Sri- <br /> Independent <br /> `S, <br /> Independent Contractors X "C F <f" E" $ 500,000 Each Occurrence <br /> Products X C,f S, '°e. tR.. {Aggregate <br /> Products <br /> Completed Operations x �= s1-y_ ' $ 500,000 {Aggregate Comp. Operations <br /> Contractual Xr - <br /> s' J I <br /> PROPERTY DAMAGE a ,„ <br /> Premises Operations X .{.; 4UU2a11 4/97/2 "''4 f 9/73 $ 100,000 Each Occurrence <br /> Elevators $ 100,000 Aggregate Oper. <br /> Independent Contractors X $ 100,000 Aggregate Protective <br /> Products 7r $ 100 000 Aggregate! Products <br /> Completed Operations 1 (Aggregate Comp. Operations <br /> Contractual - $ 100,000 Aggregate Contractual <br /> AUTOMOBILE LIABILITY <br /> BODILY INJURY <br /> Owned Automobiles, x EC 4002311. 4/9/72 4/9/73 $ 250,000 Each Person <br /> Hired Automobiles , X <br /> Non-owned Automobiles , $ 500,000 Each Occurrence** <br /> PROPERTY DAMAGE /� <br /> Owned Automobiles x EC 4002311 4/9/72 4/9/73 <br /> Hired Automobiles K ( $ 100,000 Each Occurrence** <br /> Non-owned Automobiles Y, <br /> ALL, DFERATIONS OF THE INSURED' <br /> <_ <br /> This Certificate of Insurance is not valid unless it is countersigned by a duly authorized representative of the Company. <br /> *Absence of an "X" in these spaces means that insurance is not afforded — --„ <br /> with respect to the coverages or hazards opposite thereto. <br /> **The word "accident" is substituted for the word "occurrence" when policy - �r 7 t'� <br /> form G4303 is indicated in the "POLICY NUMBER" column. (Authorized Re Desert f ,� �,y, {__�•� "" <br /> tIf more than one kind of insurance is written on one policy, the policy <br /> number need not be repeated. p �� MAY 30 1972�t� <br /> G75950f3 17111 W <br /> 1. ORIGINAL f <br />