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Home My WebLink AboutAmbulances - Miscellaneous Insuranc 1970-1984 I r STATE P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 12-19-84 POLICYNUMBER: Grp. 236-#71-85 CERTIFICATE EXPIRES: 1—1-86 F , City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 Attn: Business License Dept . L This is to certify that we have issued a valid Workers'Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. We will also give you TEN days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. �� RESIDENT EMPLOYER r Schaefer Ambulance Service , Inc . P .O. Box 74697 Los Angeles , CA 90004 L STATE P.u. ,30X 807, SAN FRANCISCO, CALIFORNIA 94-,)l y COMPENSATION M I N S U R A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 8-2-84 POLICY NUMBER: Grp . 236-#71-84 CERTIFICATE EXPIRES: 1-0 1-85 F- Of f ice of the City Attorney ENDORSEMENT :ff2065 rNTITLED SPECIAL P .O . Box 190 CANCELLATION lu I ;E EFFECTIVE 200 Main Street IS ATTACHED TO AND FORMS A PART OF Huntington Beach, CA 92648 THIS. POLICY. SPECIMEN ENDORSEMENT Attn : Gail Hutton, City Attorney #2065HTTACHED. L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. 30 This policy is not subject to cancellation by the Fund except upon V5tdays'advance written notice to the employer. 30 - We will also give you THR days'advance,notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ��"' RESIDENT EMPLOYER Schaefer Ambulance Service, Inc . P .O . Box 74697 Los Angeles , CA 90004 tl 3.) AFFROVED AS TO FORl�a GAIL HUTTON city Attorney SCIF 10262(REV. 11-83) By: _ OLD 262A --- - nAn„t.v City .Attornay / y �i ' • COARPENS.l710N • INSURANCE CERTIFICATE HOLDERS' NOTICE ENDORSEMENT AGREEMENT HOME OFFICE SAN FRANCISCO ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THIS POLICY SHALL NOT BE CANCELLED UNTIL: 3o DAYS AFTER WRITTEN NOTICE OF SUCH CANCELLATION HAS BEEN PLACED IN THE MAIL BY STATE FUND TO CURRENT HOLDERS OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE. 5 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS. CONDITIONS. AGREEMENTS. OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY. ALTER. WAIVE OR LIMIT THE TERMS. CONDITIONS. AGREEMENTS OR LIMI- TATIONS OF THIS ENDORSEMENT. COUNTERSIGN D AN FflN IS 2065 1 CXE 'JTW IC C R DENT _ 3/8 3 PRESIDENT SCIF FORM OP 217 1REV. 1•811 V V v u fia@ IujD%a'* ft4 doj- ( j � O� � ISSUE DATE(MM/DD/YY) ln)i� LJ L 7-25-84 1co PRODUCER THIS CERTIFICATE IS ISSUED AS A CHATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED EIY THE POLICIES IDELOW. Gregg & Associates 1129 E. Missouri CoC�`1pGMES AFFOa M C OVERIAGE Phoenix, AZ 85014 COMPANY Q LETTER INSURED COMPANY Q Pittsburgh, PA Schaefer Ambulance Service, Inc. COMPANYP.O. Box 74697 LETTER Los Angeles, CA 90004 COMPANY p LETTER COMPANY LETTER THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR NAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS,AND CONDI- TIONS OF SUCH POLICIES. CO POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS LTR TYPE OF INSURANCE POLICY NUMBER DATE(MWOD/YY) DATE(MM1DD/YY) EACH AGGREGATE OCCURRENCE GENERAL LIABILITY BODILY AMENDED X COMPREHENSIVE FORM INJURY $ X PREMISES/OPERATIONS PROPERTY UNDERGROUND DAMAGE $ $ EXPLOSION&COLLAPSE HAZARD X PRODUCTS/COMPLETED OPERATIONS FBP 982 16 78 7-01-84 7-01-85 X CONTRACTUAL C &PD COMBINED $ 500 $ 500 X INDEPENDENT CONTRACTORS X BROAD FORM PROPERTY DAMAGE X PERSONAL INJURY PERSONAL INJURY $ 500 X Prafessinnal Linhi it AUTO^J OMLE LIABILITY BODILY INJURY X ANY AUTO (PER PERSON) ; ALL OWNED AUTOS(PRIV. PASS.) BODILY ALL OWNED AUTOS(PRIVPASS. INJURY(PER ACCIDENT) X HIRED AUTOS PROPERTY X NON-OWNED AUTOS BA 928 67 21 7-01-84 7-01-85 DAMAGE $ GARAGE LIABILITY COMBINED $ 500 EXCESS LIABILITY X UMBRELLA FORM COMB NED $ 10,OOC $ 10,000 OTHER THAN UMBRELLA FORM MU 952 58 91 7-01-84 7-01-85 WORKERS'COMPENSATION STATUTORY AND $ (EACH ACCIDENT) EMPLOYERS'LIABILITY (DISEASE-POLICY LIMIT) APPROVED AS TO F $ (DISEASE-EACH EMPLOYEE) OTHER GAIL HUT ON City Att rney DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS By: Deputy City Attorney City of Huntington Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- PIRATIOV DATE THEREOF, THE ISSUING COMPANY WILL X %WXXX TO ATTN: City Administrator MAIL JQ.'DAYS WRITTEN NOTICE TO THE CERTIF AYE HOLDER NARKED TO THE P.O. BOX 190 LEFT, xTs�»sxx Huntington Beach, CA 92648 AUTHORIZED REPRESE V v 3 , ) L�- b is U R. 11 - � NATIONAL INDEMNITY COMP, M 2 U 3024 Harney Street W 19/ Omaha, Nebraska 68131 CITY Of. HUN!NaiOI^•l BEACH CERTIFICATE OF INSURANCE ADM!'aicTf?AT!!!F OFFICE This certificate of insurance neither affirmatively or negatively amends, extends or alters the coverage afforded by the Policy Dr Policies number- 4-25-77 19 ed in this certificate This is to certify that the following described policies have been issued and are in full force and effect. NAME OFINSUREDSchaefer Ambulance Service & Jacob Schaefer an Individual P.O.ADDRESS 4627 Beverly Blvd, Los Angeles, Calif LOCATION COVERED 58 Miles from seeiRig point DESCRIPTION OF WORK Ambulance Service POLICY NO. KIND OF INSURANCE LIMITS EFFECTIVE EXPIRES Workmen's Compensation Legal and Employer's Liability For each item show"Not Covered"if no .-J coverage afforded. General Liability: Bodily Injury: . . . . . . Each Occurrence $ =' — •? Aggregate-Products- t7 Completed Operations T Propertyzz- Damage . . . . Each Occurrence $ Aggregate-Operations $ Ld) Aggregate- Products- _ Completed Operations $ n W ' Automobile Liability: Bodily Injury . . . . . . Each Person $ 100400 Each Occurrence $ 300,000 BA 131262 Property Damage . . . . Each Occurrence $ 509000 3-26-77 to 3-26-78 Covers:As per fleet schedule on policy Excess Liability. ❑ Automobile General Liability Name of Primary Insurer: Primary Limits: Excess Limits- In the event of any material change in or cancellation of said policies, NATIONAL INDEMNITY COMPANY intends to notify the party to whom this Certificate is addressed of such change or cancellation, but undertakes no responsibility by reason of any failure so to do. NATIONAL INDEMNITY C MPANY This Certificate issued to: City of Huntington Beach By p-n- eox igo CIO -W-ilat-1p9tna Reach, 'Calif 92648 Title Authorized Representa ive Attn: City Administrator End #14 U-100e(1/73) NOTE TO AGENT —Mail Copy to Home Office immediately. OATIONAL INDEMNITY COMPANY 3024 Harney Street THOMPSON POWELL CO. Omaha, Nebraska 68131 INSURANCE BROKERS AND AGENTS 271 EAST WORKMAN AVE. CERTIFICATE OF INSURANCE COVINA, CALIFORNIA This certificate of insurance neither affirmatively or negatively amends, extends or alters the coverage afforded by the Policy or Policies number- March 26, 19 75 ed in this certificate This is to certify that the following described policies have been issued and are in full force and effect. NAME OF INSURED Schaefer Ambulance Service & Jacob Walter Schaefer an individual P.O.ADDRESS 4627 Beverly Blvd_ , Los Angeles , ra_ 90004 LOCATION COVERED 50 miles from basing point- DESCRIPTION OF WORK Ambulance Service POLICY NO. KIND OF INSURANCE LIMITS EFFECTIVE EXPIRES Workmen's Compensation Legal and Employer's Liability For each item show"Not Covered"if no coverage afforded. General Liability: Bodily Injury: . . . . . . Each Occurrence $ . r , Aggregate-Products- Completed Operations $ Property Damage . . . . Each Occurrence $ Aggregate-Operations $ Aggregate- Products- Completed Operations $ Automobile Liability: Bodily Injury . . . . . . Each Person $ 100,000 BA 106286 Each Occurrence $ 30.0;000 Property Damage . . . . Each Occurrence $ 50,00() 3-26-75 to 3-26-76 Covers: Excess Liability: ❑ Automobile ❑ General Liability Name of Primary Insurer: Primary Limits: Excess Limits: In the event of any material change in or cancellation of said policies, NATIONAL INDEMNITY COMPANY intends to notify the party to whom this Certificate is addressed of such change or cancellation, but undertakes no responsibility by reason of any failure so todo. Original mailed to certificate holder NATIONAL INDEMNITY COMPANY This Certificate issued to: City of Huntington Beach By (O Box 190 H in ing nn Reach, Ca A2648 Title Aut�hsx-iae.d--rgY -itive Attn: City Administrator U-100e(1/73) NOTE TO AGENT— Mail Copy to Home Office immediately. Return original and three copies of Wnly City of Huntington Beach's form completed certificate Certificate of Insurancewik a, CERTIFICATE OF I'NSURANCE I- City of Huntington Beach TO CITY OF HUNTiINGTON BEACY.-P,�L[Fql�NIA,-�:j Huntington Beach,California 92648 A MUNICIPAL CORPORATION .34 �n| .ea/'n�� n�o�/o�ni, ��e �^�� »�ven / \` �� `� | M � ^��} '2 � H This is to certify that the policies of insurance been issued to the ' mu �Qnmdand uminfonmau this dmo. |fthoo pdi�ooamobhoeUAddr chuhga�]n r�u�n�'munno fia vvmaf&�t�nm insurance company agrees tu give 30dayo prior Written notice,by mail,to City of Huntington 8oach.P.0. Box ]SO' Mwm i��w~' Beach,California Q2G4O. Name ofInsured Address ofInsured 462' B'e,=rlx Blvd. " Location of Insured Operations Various F Description ofOperations POLICY D TE LIMITS OF LIABILITY POLICIES IN FORCE NUMBER EFF!��TIVE EXPIRATION Employers' Liability B. Public Liability: $1,000,000 combined single Bodily Injury: limit per occurrence. Manufacturers and Contractors $ Each Person Comprehensive General F-1 $ -Each Accident (including products completed Property Damage $ Each Accident C. Automobile Liability: Bodily Injury (see reverse side fo r $ 100*000 Each Person excess I iabi I ity) $ zoo*000 Each Accident Property Damage $ 50*000 -Each Accident Does policy cover: All owned automobiles x) Yes 0o Non-owned automobiles < }Yoy ( ) No Hired automobiles Yes No ` D. Additional Insured Endorsement: The insured agrees that the City of Huntington Beach City Council,and/or all City Council appointed committees, commissions, boards and any other City Council appointed body, ��o elective and appointive officers, servants or omp|uyms of the City of Huntington Beach, when acting as such are additional mmumdo hereunder. E. Hold Harmless Agreement: The insured agrees to protect' defend, indemnify and save harmless the City of Huntington Beach against loss,damage or expense by reason of any suits,claims,demands,judgements and causes ofaction caused by insured,his employees,agents or any subcontractor arising out of or in-consequence of the performance of all or any operations covered by the certificate of insurance,and such insurance shall be primary toany insurance of the city. F. Minimum Limits Required: Combined Single Limit Bodily |niwr/ and/or Property Damage including Products Liability: $1,000,000cmmbnod ,inV|o4mit per occurrence. CHICAGO INSURANCE COMPANY POLICY # 283-097977 Term: March 26, 1976 to March 26, 1977 Insured: Schaefer Ambulance Service, Inc, Coverage Excess Automobile _Liability Limit: The difference between: $1 ,000y000. combined sing,l_e __Limit, _bodily injury, and property damage liability combined, each :.O'ecurrence and Underlying limits. Dated: Jan. 3, 1977 CHICAU INSU E COOMMBBANY BY t n :x i w'rJit w INN /I r,r nT n TTET To- City of Huntington Beach Attn: City Administrator Box 190 Huntington Beach, California 92648 Schaefer Ambulance Service and Jacob Walter RF: I?iGU9 D,- Schaefer,- an individual NL o9-68-04 DEaUR SIRS- IDT ACCORDADICE Wrl'ff M TEM B OF ` TIT CC,E r°L'I(I'ATE ISSUED TO YOU, PIEz'tSE BE ADVISED ISED THAT `ME ABOVE CAPTI'0`TED P,)LICY IS C.U410ELLED 1,117FPCTI7TEE March 26, 1975 REZ'.SE ACIGTOfvLEDGE RECEIPT OF THIS DO TICS 0-NT T112 RICLOSED DIP-LIC?tTE COP°f OF THIS NOTI*.r'I"<<ATION. 1117T D-K YOU. sIT10E,?EI.Ys a C1,17, � D. F. AIdI}�R SON N{ rrvT lr(_,v ST l JT TO- City of Huntington Beae h Attn: City Adrain i strator Box 190 Huntington Beach, California 92648 80haefer imbulance Service and Jacob l,!dlter E- I1T )ML E,D. Sr_;haoLr fer,, an individual, yy rr l;•^r�P . ld 09,6 8-O4 IIT �CC0 '7. '�TCE W 'I?fi T TE S OF THE CERT71CATE I IXIM TO YOU, PLE,ASE DO 4NMED T AT T 1TE ABOVE CA IOPTLD i"`1z.ICY .1 S CMICI�T�ISD =I,rrTI-VE March 2b,, 1975 PLC:?SF .CIT TO-•,EDGE' R-I CµZPT OF THIS 110T1Cr 01` TIE-3 F-,[CTOSED DIJ-P IC?'MN COPY OF THIS NOTIFICATION. `.I'I".P.M YOU. S irlc::;,s I;Y,y ® NORfHLAND INSURANCE COMPANY ❑ COASTAL CASUALTY COMPANY Hamm Bldg., St. Paul, Minnesota 55102 CERTIFICATE OF INSURANCE Issued To: I! City of Huntington Beach THomPSON -POWELLCo. Attn: City Administrator - BROKER Box 190 Huntington Beach, Ca. 92648 271 E.WORKMAN ST VINA,CALIFORNIA J ' -4031 This is to certify, that policies in the name of: .9chaefer Ambulance Service and Jacob Walter Schaefer an individual of 4627 Beverly Blvd. , Los Angeles , California 90004 are in force as follows: POLICY COVERAGES POLICY NUMBER PERIOD LIMITS Automobile NL 096804 Dec. 10, 1974 Bodily Injury Dec. 10, 975 10Q000 each person g 300,000 each accident Automobile Property Damage NL 096804 Dec. 10, 97450 ,000 each accident Dec. 10, 975 Fire, Theft, etc. $ Collision $ deductible Cargo $ In the event of any material change in or cancellation of said policies the company will notify the party to who this certificate is issued of such change or cancellation. This Certificate of Insurance neither affirmatively nor negatively amends, extends, nor alters the coverage afforded by the policy or policies numbered in this certificate. Authorized Representative N-189 (4/73) lz tr �Z -ay, r, u CERTIFICATE OF INSURANCE H� 11t116TF01�D m Hartf ire Insurance Company o L61 N ork I.Jnderwriters Insurance Company l\sUx:\�ci:cituup o®Hartfor Accident and Indemnity Company o[71 Tw City Fire Insurance Company HARTFORD.CONNECTCUT c ® hiartford Casualty Insurance Company Co.Code THOMPSON -POWELL 5 Named Insured and_Address INSURANCE BROKERS SCHAEFER AMBULANCE SERVICE 271 E.WORKMAN ST.IV COVINA,CALIFORNIA 4627 Beverly Blvd . Los Angeles , Calif. TELEPHONE: 332-4031 -- - i The policies indicated herein apply vrith respect to the hazards and for the coverages and limits of liability indicated by specific entry herein but this certificate of insurance does not amend, extend or otherwise alter the terms and conditions of the insurance coverage in the policies identified herein. Coverages and limits of Liability _ (SINGLE LIMIT) (DUAL LIMIT'S) Policy Number Bodily Injury and Bodily Injury Liability Property Damage Liability Hazards and Property Damage Liability Policy Term each Ieach aggregate oceach aggregate occurrence aggregate occurrence currence General Liability 71C212942 Premises-Operations 12—10—7 3 74 $ 500 ,0001S 500 000 S '000 XXXX $ 0008 000 Independent Contractors I $ 000$ ,000 S 000 XXXX $ 000$ 000 Completed Operations; Products $ 000S ,000 S ,000 S 000$ ,000 S 000 Contractual(as describes] below) S 0001S ,000 S 000 XXXX $ ,000 S 000 Coverages and Limits of Liability (SINGLE LIMIT) (DUAL LIMITS) Policy Number Bodily Injury and Bodily Injury Liability Property Damage Liability Property Damage Liability Hazards and Policy Term *each *each *each aggregate occurrence aggregate each person occurrence occurrence Automobile Liability Owned Automobiles 11 $ 500 ,0001 XXXX $ 000$ 000$ 000 XXXX Hired Automobiles S 000 XXXX $ ,000 S 000 S 000 XXXX \ton-Owned Automobiles S 000 XXXX S 000 S 000 S 000 XXXX Workmen's Compensation Compensation—Statutory and Employers' Liability Employers' Liability — $ '000 Umbrella Liability j S 1000,000 *If with respect to Automobile Liability the Policy Number entered above includes the symbol GB,A%,MVP, MAG or PGB,the word "occurrence" is amended to read "accident". Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and date.) All vehicles and operations City of Huntington Beach If policy is canceled, 10 days Attn: City Administrator Avritten notice will be given to: $OX 190 l Huntington Beach, Calif. 92648 Yf Grt":"S 11- POWELL CC. IN t AP E gFlfl�' S t EFTS Date Nov. 29, 1973 By........... . .�,.. ..... ............. ........................... Autl,ion.zed Representative Form:\L-12-3 CERTIFICATE OF IN, I-A,NCE i ❑ IIOLLAND•A--NIERICA INSURANCE CO)If'ANY ] IAIISSION INSURANCE CO-TFANY ❑ SA1'RE & TOSO, INC.NAh!l c D INSURED • SCHAEF ER ' S At13ULANCE SERVICE , I NIC 4267 BEVERLY °OULEVARQ • . LOS ANGELES , CALIFORNIA 90004 CERTIFICATE CITY HALL CERTIFICATE ISSUED TO • CITY OF HUNTINGTON BEACH ISSUED BY • MISSION INSURANCE C0,11PANY • HUNTINGTON BEACH, CALIFORNIA • 2601 W i LSH I RE BOULEVARD • • LOS ANGELES , CALIFORNIA 900 HOLLAND-AMERICA INSURANCE CO,'APANY and/or %1ISSION IwSU>ANCE COYPAN'Y and/or SAYRE AND TOSO. WC. has issued coverage effective as of the doses and for the ceriods and limits specified below end sudject to all terms, conditions, previsions, exclusions and limitations of the described 3in6ers or Policies wretner shown by endorsement or eri erwise. Any requirements or provisions in any contrect or agreement between. the Insured and any os%•:er person, firm, aging, altering or amending the definition of i,isui 2a or any u."ne r e r m5 or rCi��..!ons o-th;s c e r KI'QD OF !"'c"=ANC= -C � LIt.1!TS OF LIABILITY - COMPENSATION VJO?K&'.ENJ'S CO,:'.PENSATICN WCP RY CALIFORNIA CO,1APENSATiON C01.1PE,NSATION ! RY COMPENSATION STATES) OF KA1EN'S CO.`:,P=`iSATION I R'S LIAB,LITY LIABILITY . - i - - --- I EACH PERSON EACH CCC�.=-ENCE BODILY IN;URY LIABILITY- I NCLUD I;tdG MALPRACT ICE 10,000 CQt10 I NED AUTOMOBIL-1 I S S IHAC 11589 11 EACH PERSON EACH OC.CJR.RENC.E EFF7" 1 "72 S _ _ $ PROPERTY D%+1:1A.GE LIABILITY AU10 'Oc•ILE I 1EXP7 -1 -7 % t S^I�NGL.E L11`11T- iE-Al`H OCCURRENCE ` `y/ L,"4y.vV �r.i1V" •.V.L'Y I I I 5...!'t: .^•'--'v,. _ •ram. L �.( .. .k;y T L S1-X/,IYJ. .A '-11 NOT COVERED S NOT AUTOMOBILE PHYSICAL DAMAGE 1 COMPREHENSIVE EFF S FIRE, LIGHTNING & TRANSPORTATION S THEFT (BROAD FORM) EXP S COLLISION OR UPSET i �;- r^ne.• .i vim• r r- --ACTUAL LESS S DEDUCTIKE "THIRD PARTY P^OPER Y DAMAGE; �, ,^ M� s\� . UMBRELLA EXCESS POLICY` 'r If - /_ EFF, Effective '•-.'. rmriv loss .under.-Rhy-si .!- D=27 . _.. _- d Insured .�_p�:,:c�Ie_us_interests may appear to me Name and the Lienhoider „amcd below in accordance with Loss.P�ycale E3rdd§sem-E reC;e.•se sizi.71E ' LIENHOLDER • _.. — -� e As respects the foliowin•a described outemobiJefs): YEAR TRADE NAME 4 301)Y TYPE AND 'MODEL ) SERIAL NUMBER J U L 11, 1972 DESCRIPTION AND LOCATION OF OPERATIONS "OTHER THAN AUTOMOWLE This policy shall not be canceled nor reduced in coverage until after 10 days written notice of such cancelation. or reduction in covercge shah have been mailed to this certificcte holder. Certified this 7TH day of JULY 19 72 i II0LI,AND.a.11FrTCA INSL'RAN-CE COMPANY DIL�SION INStiIiA., Ct)1IP�1NY 0 SAYItE S TOSO, INC. Producer PFtoN r.FRjI:RAI Ar.I-�Ir 1 rc aY-- CERTIFICATE OF INSURANCE o M Har,lqftire Insurance Company Ne k Underwriters Insurance Company THE HUTFOR,D m Hartfe o®ccident and Indemnity Company "m Twi. ty Fire Insurance Company isINSURANCE GROUP v HARTFORD,CONNECTICUT ®Citizens Insurance Company of New Jersey �I This is to certify that the company designated Co.Code herein by Co. Code has issued o h named.inc 1 S Named Insured and Address th - • •N -POWELL Coll SCHAEFER'S AMBULANCE SERVICE INSURANC BROKERS 4627 Beverly Blvd. 271 E.WORKMAN ST-W COVINA,CALIFORNIA. Los Angeles , Calif . T1 o the hazards and for the coverages and limits of liability indicated by spL�..�� .�� r� -- rrnica -ol�tnsurance does not amend, extend or otherwise alter the terms and conditions of the insurance coverage in the policies identified herein. Coverages and Limits of Liability (SINGLE LIMIT) (DUAL LIMITS) Policy Number Bodily Injury and Bodily Injury Liability Property Damage Liability Property Damage Liability Hazards and Policy Term *each aggregate each person *each *each aggregate occurrence occurrence occurrence General Liability 71C 211113 Premises-Operations 12 10_72173 $ 000$ 000$ 100 ,000$ 300 000$ 50 000$ 50,000 Independent Contractors $ ,000$ ,000$ 000$ 000$ 000$ ,000 Completed Operations; $ 000$ 000$ 1000$ 1000$ 000$ 000 Products $ 000$ 000 Aggregate: $ 1000 XXXX XXXX Contractual(as described below) $ 000$ 000$ 000$ 000$ 000$ ,000 Automobile Liability Owned Automobiles $ ,000 xxxx $ 100 ,000$ 500 ,000$ 100 moo xxxx Hired Automobiles $ ,000 XXXX $ 000$ 000$ 1000 XXXX Non-Owned Automobiles $ 000 XXXX $ 000�$--,000 $ ,000 XXXX Workmen's Compensation Compensation—Statutory and Employers'Liability Employers' Liability — $ ,000 Umbrella Liability $ 000,000 *If with respect to Automobile Liability the Policy Number entered above includes the symbol GB,AZ,MVP,MAG or PGB,the word "occurrence" is amended to read"accident". Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and date.) All vehicles and operations If policy is canceled, 10 days City of Huntington Beach written notice will be given to: Attn: City Administrator Box 190 HufN,agton �Beanh, alif. 92648 VI INS AN BR OK A TS DateDec. 21, 1972 By....Y...... .............. .................... . ................................................. Authorized Representative Form AL-12-2 Printed in U.S.A. 9-'70 k CER I IC_�;"o F OF i-NSURAhCE IIOLLAtiD•AMERICA I'NSL'TTRA CE C0JVK-ANW 5j 'M SSION I.NSti -:NCE C031P.AINL Y NAMED . L'Cd w 3`LOS�, INC. D INSURED • SC14AEFERIS AMBULAtXE SERVICE' , INC * ! 4267 BEVERLY SOULE"'RD LOS ANGELES , CALIFORNIA 90004 DEC 2 61972 CERTIFICATE CERTIFICATE CITY OF HUNTINGTON BEACH ISSUED TO fl CITY OF HUNT I NGTON BLEACH ISSUED BY • M I SS MINISQR (WROVI " COMPANY • . ATTEN: CITY ADMINISTRATOR • 2601 WILSHIRE 30ULE%!:;RD • BOX 190 • LOS ANGELES , CALIFORNIA 900c' HOLLAND-AMER!CA INSU?ANCE COMPANY anc '14NC_ CO.ti',PANY and!or SAYRE AND TOSO, INC. has issued covercoe effective as of the dates end ;or the r.eriocis cnd ii ^ nil terms, conditions, provisions, exclusions and Iimitoticns of the dt<_ribed Binders or Pcli ies .:hether '-c•,,. ents ar orovisigns in cc .re-=+- _any tract-^ n,!nt >=e'v;•e_n tl•:e insured cnd any other person, 7,,m crginJ, nitering or amending the definition o`. insured or any other terms or conditions of this ce. _ KIND OF lN:�'17A^JC^ { �' LhMITS OF LIABILITY COh1?cNSSATICN � ! WO=KM N S CC:^1`EN15ATICN ��/iC' fGRY CALIFORNIA COfr1PENSATION COMPENSATION -Err JTORY COAIPENSATl0Nd STATE(S) OF _ WORK?5EN S CG1,'•PENS_ATIGN �EXP !Jif\1E'.I,PLOYER S 'LIABILITY S P_R OCCI;<;c�!CE LIAEILITY , EACH Pc?SON EACH OCCU = tCE BODILY INJURY LIABIL!TY-� I NCLUD III4G M.I P R A C T I CE � 10, 000 COMB I F�SO_ A'JTC),Y^-5iLE I b EACH PERSON S EACH OCCUr;ENCE X-X,yk:'1;':;;�'ri v , EFF7 1 -7 2 S 3 P2pPE, TY DAMAGE LIA21LITY I tAC.H OCCURRENCE ^�+ ^ A�,T�.. ;-,, i � c�p7m ; 'r � 1 . S ! t-jI-I ` I_ It,+ ITa `,�ru nrrll� c JJ 1 '�f I 1 1 1'S V VV t\l_IlV 4 C.A r"{,.l •..E:i�C P °.1:_p,'�T._.'l _ I ` - —FtCH •.rCURQ NCc A'r GR-F-41r NOT CC AUTO/402 E PHYSICAL DAMAGE COMPREHENSIVE �i _1 FIRE, L!GHTN!NG p TRANSP RTIA-VON'. S THEFT (BROAD E COLLISION OR UPSET C-A-'!N VALUE iESS S pcDU'Y:plc **THIRD PARTY NIOPERTY DA.M..AJEE�F — S rxp UMBRELLA EXCESS POLICY EFF t Xp Effective any loss under Physical Derna?e Coveroee is payable es interests may cppeor to the Named Insured and.the Lienholder ncmed below in accordance with Loss Poyabie Endorsement on reverse side. LIENHOLDER • • As respects the following described outomobile(s): YEAR TRADE NAPj%E I 3CDY TYPE AND mODEL_T SERIAL NUMEER JUL 1 1 1972 DESCRIMCN AND LOCATION OF OPERATIONS .*OTHER THAN AUTOMOBILE This policy shall not be canceled nor reduced in coverage until after 10 days written notice of such cancela'ion or reduction in coverage shall have been mailed to this certificate holder. Certified this • 7 TH day of . J ULY 19 72 C IIOLLAND•AMERICA IN-f L'RANCE COMPA.STY MISSIONIN-SUK T\CE CO.IIF':1\Y SA IZZE & TOSO, INC. raducer r)Chjt1 I`cl17C•o A s CERTIFICATE OF INSURANCE ITOLLAND•AMERICA INSURANCE COMPANY ® MISSION INSURANCE COMPANY NAMED ❑ SAYRE & TOSO, INC. INSURED . SCHAEFER' S AMBULANCE SERVICE , INC . • 4267 BEVERLY BOULEVARD • . LOS ANGELES, CALIFORNIA 90004 CERTIFICATE CITY HALL CERTIFICATE ISSUED TO . CITY OF HUNTINGTON BEACH ISSUED BY • MISSION INSURANCE COMPANY HUNTINGTON BEACH, CALIFORNIA • 2601 WILSHIRE BOULEVARD • • LOS ANGELES , CALIFORNIA 9005i HOLLAND-AMERICA INSURANCE COMPANY and/or MISSION INSURANCE COMPANY and/or SAYRE AND TOSO, INC. has issued coverage effective as of the dates and for the periods and limits specified below and subject to all terms, conditions, provisions, exclusions and limitations of the described Binders or Policies whether shown by endorsement or otherwise. Any requirements or provisions in any contract or agreement between the Insured and any other person, firm or corporation will not be construed as enlarging, altering or amending the definition of insured or any other terms or conditions of this certificate or the policy designated. KIND OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY _ COMPENSATION W C P 11045- E117-1 -7 2 STATUTORY CALIFORNIA COMPENSATION WORKMEN'S COMPENSATION EXP 7-1 -7 3 _ COMPENSATION EFF STATUTORY COMPENSATION STATE(S) OF WORKMEN'S COMPENSATION EXP EMPLOYER'S LIABILITY $ PER OCCURRENCE LIABILITY EACH PERSON EACH OCCURRENCE BODILY INJURY LIABILITY- I NCLUD I NG MALPRAC ICE 10 000 COMBINED AUTOMOBILE $ EACH PERSON $ EACH OCCURRENCE X310XINLX=04XN"X HAC 11589 XXX"*X((1X EFF7-1 -7 2 $ EACH OCCURRENCE $ PROPERTY DAMAGE LIABILITY AUTOMOBILE EXP]-1 -]3 $ SINGLE LIMIT- EACH OCCURRENCE .Y-Y&�*X�+�'��gYr l� �!j 1�C EACH OCCURRENCE AGGREGATE ,ad.aaNtJPIJ�(Ch' fJtsACd $ NOT COVERED $ NOT COVERED AUTOMOBILE PHYSICAL DAMAGE COMPREHENSIVE EFF $ FIRE, LIGHTNING & TRANSPORTATION $ THEFT (BROAD FORM) EXP $ COLLISION OR UPSET ACTUAL CASH VALUE LESS $ DEDUCTIBLE "THIRD PARTY PROPERTY DAMAGE EFF EXP $ UMBRELLA EXCESS POLICY EFF EXP $ Effective any loss under Physical Damage Coverage is payable as interests may appear to the Named Insured and the Lienhoider named 'below in accordance with Loss Payable Endorsement on reverse side. LIENHOLDER • • As respects the following described automobiJe(s): YEAR TRADE NAME BODY TYPE AND MODEL SERIAL NUMBER DESCRIPTION AND LOCATION OF OPERATIONS "OTHER THAN AUTOMOBILE This policy shall not be canceled nor reduced in coverage until after 10 days written notice of such cuncelation. or reduction in coverage shall have been mailed to this certificate holder. Certified this 7TH day of DULY 19 72 ❑ HOLLAND-AMERICA INSURANCE COMPANY Xj MISSION INSURANCE COMPANY ❑ S YRE & TOSO, INC. Producer PENN GENERAL AGENCIES BY �� - Authorized Representative CERTIFICATE OF INSURANCE ❑ IIOLLAND•AMERICA INSURANCE COMPANY ® MISSION INSURANCE COMPANY NAMED ❑ SAYRE & TOSO, INC. INSURED . SCHAEFER°S AMBULANCE SERVICE , INC. 4267 BEVERLY BOULEVARD LOS ANGELES, CALIFORNIA 90004 CERTIFICATISSUED TO e CITY OF HUNT I NGTON BEACH CERTIFICATE ISSUED BY a MISSION INSURANCE COMPANY ATTEN: CITY ADMINISTRATOR 2601 WILSHIRE BOULEVARD . BOX 190 LOS ANGELES , CALIFORNIA 9005? HUNTINCTON BEACH, CALIFORNIA 92648 _ HOLLAND-AMERICA INSURANCE COMPANY and/or MISSION INSURANCE COMPANY andjor SAYRE AND TOSO, INC. has issued coverage effective as of the dates.and for the.per.iods and limits-specified below and subject io all terms,conditions, provisions, exclusions and limitations of the described Binders or Policies whether shown by endorsement or otherwise. Any requirements or provisions in any contract or agreement between the Insured and any other person, firm or corporation will not be construed as enlarging, altering or amending the definition of insured or any other terms or conditions of this certificate or the policy designated. KIND OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY COMPENSATION WCP 1 1045- EFF]' STATUTORY CALIFORNIA COMPENSATION WORKMEN S COMPENSATION EXP COMPENSATION _ EFF I STATUTORY COMPENSATION STATE(S) OF WORKMEN'S COMPENSATION EXP (EMPLOYER'S LIABILITY $ —PER OCCURRENC= LIABILITY EACH PERSON EACH OCCURRENCE BODILY INJURY LIABILITY- I NCLUD I NG MALPRAC1 ICE 10,000 COMBINED AUTOMOBILE $ $EACH PERSON EACH OCCURRENCE ? XI3(IXaXI �(X X�ilXt?4X HA C 11589EFF]—1 —]2 3 $ EACH OCCURRENCE PROPERTY DAMAGE LIABILITY AUTOMOBILE EXP]'1 ']3 $ SINGLE LIMIT- EACH OCCURRENCE MI ?y1XI}(? !, x '�'I EACH OCCURRENCE, AGGREGATE NOT COVERED $ NOi COVERED AUTOMOBILE PHYSICAL DAMAGE COMPREHENSIVE EFF $ FIRE, LIGHTNING & TRANSPORTATION $ THEFT (BROAD FORM) EXP $ COLLISION OR UPSET ACTUAL CASH VALUE LESS $ DEDUCTIBLE **THIRD PARTY PROPERTY DAMAGE EFF EXP $ UMBRELLA EXCESS POLICY EFF EXP $ Effective any loss under Physical Damage Coverage is payable as interests may appear to the Named Insured and the Lienholder named below in accordance with Loss Payable Endorsement on reverse side. LiEWHOLDER e e As respecis the foiiowing described automobile(s): YEAR TRADE NAME BODY TYPE AND MODEL SERIAL NUMBER DESCRIPTION AND LOCATION OF OPERATIONS "OTHER THAN AUTOMOBILE This policy shall not be canceled nor reduced in coverage until after 10 days written notice of such cancelation or reduction in coverage shall have been mailed to this certificate holder. Certified this ]TH day of JULY 19 72 G HOLLAND-ATVIERICA INSURANCE COMPANY K DILSSION INSURANCE COMPANY O SAYRE & TOSO, INC. Producer PENN GENERAL AGENCIES BY Authorized Representative HAG 9 (7.701 aM L �_s To Chi Af Earle RabItailIn Date These people n nat h"a a certificate of nee ` and necessity to operate an ambulance in the cat.; Are the s:t ll. bpima-wed sus haCk-iwa service to Seals? Please note that this is Cau. +Nation. of their liability Innuranep and, therefore„ they cannot b4C used f. the Gi- ar Rm'jy[S'M %�0 Signed a x Brander- R. Cas-tl Asst. Administrator Quz�,' Date Signed Redif�rm SEND PARTS 1 AND 3 WITH CARBONS INTACT. '-:.'.. 4S 46S' `_ PART-3 W111 BE,RETURNED WITH REPLY. FO CITYF HU TINGTON BEACH INTER-DEPARTMENT COMMUNICATION HUNTINGTON BEACH To CAPTAIN BURKENFIELD From Lt. Haslet Subject AMBULANCE SERVICE Date 8-7-72 We do not use Schaefer's Ambulance Service Inc. in the city at all, not even for a back up service for Seals. They do operate in the city occasionally on routine business calls and may be used by the County. 1 n G ( R P D R A T E D p t ELEGRAPH ADDRESS I ! 1 S u r a f�J1 7 C e OFFICES TELEX 677 136 CHCwO S4N FR♦NU SCO 3200 WIL.SHIFtE BOULEVARD Los Angeles, California 90005 CORRESPO NOENTS TELEPHONE PRINCIPAL CITIES 3 6 5-2 8 61 1.RE. 2131 U S.A AND CJANADA August 3, 1972 CITY. HALL CITY OF HUNTINGTON BEACH HUNTINGTON BEACH, CALIF, RE: SCHAEFER'S AMBULANCE SERVICE, INC. Primary Automobile Liability Policy No. CA 24 67 50 Northwestern National Casualty Company There. presently is on file with you a certificate of insurance under the above policy. This is to advise that this policy has been cancelled as of July 1, 1972. It is our understanding coverage was replaced with another carrier as of July 1, 1972 and you should have received a Certificate of Insurance noting the new carrier as of this dace. In. the event you have not received this certificate, plea3e contact: Penn General Agencies of California, Inc. 2500 Wilshire Blvd, Los Angeles, California 90057 ' Telephone: 381-3381 "'YL Authorized Representative Northwes ern National Casualty Company Authorized Rep rntative Allen T. Arch�r . CERTIFICATE OF INSURANCE CITY HALL CITY OF HUNTINGTON BEACH HUNTINGTON BEACH, CALIF . NAMEOFINSURED . SCHAEFER'S AMBULANCE SERVICE , INC . , ET AL ADDRESS 4627 BEVERLY BLVD. , LOS ANGELES , CALIF . 90004 - THIS IS TO CERTIFY AS TO THE EXISTENCE OF INSURANCE WITH NORTHWESTERN NATIONAL CAS . CO ._ AND/OR I&MA611 INSURANCE COMPANY AS DESCRIBED BELOW: RESERVE KIND OF INSURANCE AUTOMOBILE LIABILITY INCL . MALPRACTICE LIAB. POLICY NO. CA 24 67 50 EFFECTIVE FROM: . 7-1- 71 TO: UNTIL CANCELLED LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $10,000.00 COMBINED SINGLE LIMIT LIABILITY BY- KIND OF INSURANCE EXCESS BODILY INJURY LIABILITY AND PROPERTY DAMAGE LIABILITY POLICY NO. XEL 083435 EFFECTIVE FROM: 1-1- 72 TO. 1_1- 75 CERT. 2063 LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $9 9 0 ,0 0 0 . COMBINED SINGLE LIMIT EXCESS'OF LIABILITY $10,000.00 COMBINED SINGLE LIMIT. BY SHOULD THE ABOVE MENTIONED POLICY-OR CERTIFICATE BE CANCELLED, ASSIGNED OR CHANGED IN SUCH MANNER AS TO AFFECT THIS POLICY, WE WILL GIVE TEN (10) DAY WRITTEN NOTICE TO THE ABOVE NAMED HOLDER OF THIS CERTIFICATE. Dated at LOS ANGELES "M 90010 this 11th day'Of FEBRUARY, 1972 ALLEN T. AHCHElt Co. 3200 WILSHIRE BLVD.•LOS ANGELES 90005 TELEPHONE 385-2861 ?t • :K _t., r 0 INCORPORATED Insurance OFFICES 3200 WILSHIRE BOULEVARD CaliforniaCORRESPONDENTS ANCHORAGE•CHICAGO Loss Angeles C 90010 PRINCIPAL CITIES DALLAS• LOS ANGELES U.S.A. AND CANADA _SAN FRANCISCO• SEATTLE TELEPHONE (213) 385-2861 • TELEX 677.136 February 15, 1972 City Hall City of Huntington Beach Huntington Beach, California Re: Schaefer's Ambulance Service, Inc. , Et Al You will find enclosed: ❑ Policy as requested. ❑ Endorsement which should be attached to your policy. ❑ Renewal policy continuing coverage on same terms and conditions. ❑ Certificate copy of policy the original having been sent to the mortgagee. ❑ Loss Payable Endorsement, ❑ Duplicate copy of policy. ❑ Certificate of 1nsurance-XXXNXYtpW-=T4 This replaces a certificate ❑ with Harbor Insurance Company presently on file with you and is necessitated,due to a change in the excess liability carrier as of January 1, 1972. Yours very truly, ALLEN T. ARCHER CO. E. Hoss EH/DM/k encl. cc: Insured cc: Penn General Agency CERTIFICATE OF INSURANCE . CITY HALL CITY OF HUNTINGTON BEACH HUNTINGTON BEACH, CALIF. NAME OF INSURED . SCHAEFER'S AMBULANCE SERVICE, INC. , ET AL ADDRESS 4531 Beverly Blvd. , Los Angeles, Calif. 90004 _ THIS 1S TO CERTIFY AS TO THE EXISTENCE OF INSURANCE WITH NORTHWESTERN NATIONAL CASUALTY CO. AND/OR HARBOR INSURANCE COMPANY AS DESCRIBED BELOW: AUTOMOBILE KIND OF INSURANCE U000DOU LIABILITY INCLUDING MALPRACTICE LIABILITY POLICY NO. CA 246750 EFFECTIVE FROM: 7-1-71 TO: UNTIL CANCELLED LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $10,000.00 COMBINED SINGLE LIMIT LIABILITY BY KIND OF INSURANCE EXCESS BODILY INJURY LIABILITY.AND PROPERTY DAMAGE LIABILITY POLICY NO. 109960,#159 EFFECTIVE FROM: 7-1-71 TO: 1-1-74 LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $ 990,000.00 COMBINED SINGLE LIMIT EXCESS OF LIABILITY $10,000.00 COMBINED SINGLE LIMIT. j' BY SHOULD THE ABOVEWENTIONED POLICY OR CERTIFICATE BE CANCELLED, ASSIGNED OR CHANGED IN SUCH MANNER AS TO AFFECT THIS POLICY, WE WILL GIVE TEN (10) DAY WRITTEN NOTICE TO THE ABOVE NAMED HOLDER OF THIS CERTIFICATE. Dated at LOS ANGELES RM 90010 this 24th day of June, 1971 ALIEN T. Aazcum Co. 3200 WILSHIRE BLVD.•LOS ANGELES 90005 TELEPHONE 385-2861 �tKssrs�f�st yr ss•d�us<f�svLt A IlEi'IO][.0;i A -A3aEUICA Ili SU0 CE C0,11PAN Flo—SSI 1rN IiadSU A-I CE C031PANY NAMED —1 SAY PE'' & ' OS0, INC. INSURED • SCHAE TEVS A11BUL. CE SERVICE, INC., ET AL 4631 BE;VERLY BOULEVARD • LOS A;3GELES, CALIFORNIA 90004 CERTIFICATE CERTIFICATE ISSUED T o €;ITY FALL ISSUED BY e ALEXANDER. & ALEXANDER, INC. • CITY OF 1=DgG N BEACH Q 3550 WILSHIRE BOULEVARD 0 h'MILNGT+ON BEACH, CALIWUM o LOS A1NGE;LES, CALIFORNIA 90010 HOLLAND-AMERICA INSURANCE COMPANY and/or MISSION INSURANCE COMPANY and+ier SAYRE AND TOSO, INC. has issued coverage effective as of the dates and for the periods and limits soecified below and subject to all terms, conditions; provisions, exclusions and limitations of Tile described ui::aers or Policies whether dhovvn by endorsemenr or otherwise. An v requirements or provisions in any contract or ag;eenre;;r between the Insured and any other person, firm or corporation will not be consiwed as enlarging, altering or amending the definition of insured or any other terms or conditions of this certificate or the policy designated. KIND OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY COMPENSATION EFF WORKMEN'S COMPENSATION STATUTORY CALIFORNIA COMPENSATION EXP ,— COMPENSATION EFF STATUTORY COMPENSATION STATE(S) OF _ WORKMEN'S COMPENSATION I EXP EMPLOYER'S LIABILITY 5 PER OCCURRENCE LIABILITY -�— EACH PERSON EACH OCCURRENCE BODILY INJURY LIABILITY( AUTOMOBILE $ $ EACH PERSON EACH OCCURRENCE BODILY INJURY LIABILITY EXCEPT AUTOMOBILE RAC 11202 EFF 7/1/71 $ 500,000. SINGLE LIMIT PROPERTY DAMAGE LIABILITY EACH OCCURRENCE, BODILY INJURY & AUTOMOBILE EXP 7/1/72 $ PROPERTY DA14AGE COFIBIINED PROPERTY DAMAGE LIABILITY EACH OCCURRENCE AGGREGATE EXCEPT AUTOMOBILE S $ AUTOMOBILE PHYSICAL DAMAGE COMPREHENSIVE EFF I $ FIRE, LIGHTNING & TRANSPORTATION $ THEFT (BROAD FORM) EXP $ COLLISION OR UPS=T ! ACTUAL CASH VALUE LESS S DEDUCTIBLE t6THIRD PARTY PROPERTY DAMAGE EFF EXP $ UMBRELLA EXCESS POLICY EFF EXP $ Effective- _any loss under Physical Damage Coverage is payable as interests may appear to the Named Insured. and the Lienholder named below in accordance with Loss Payable Endorse men c5n reverse side. LIENHOLDER • As respects the following described automobile(s): YEAR TRADE NAME BODY TYPE AND MODEL ! SERIAL NUMBER Policy Cancelled j I i Effective '7-26-71 R. Tartag1i0 DESCRIPTION AND LOCATION OF OPERATIONS "OTHER THAN AUTOMOBILE This.policy shall not be canceled nor reduced in coverage until aftet30 days written notice of such cancelation or reduction in coverage shall have been mailed to this certificate holder. Certified this 17th day of DUNE 19 71 Ki 1I01 L3ND-AMERICA INSURANCE Co`[PA Y ❑ :1ITaSTON IN,SU-RAN-CE CO3IPANY Fl SNYRE S TOSQ,; INC. Producer BY Auihorized'R Nresen�e CLKIIVIC;AIL UV INSUKANCL FL ii^OLLAND-AMERICA INSUI&CE COMPANY ❑ OSSION INSURANCE COMPANY NAMED ❑ SAYRE & TOSO, INC. INSURED • SCHAEFER'S AMBULANCE SERVICE, INC. , ET AL 4631 BEVERLY BOULEVARD LOS ANGELES, CALIFORNIA 90004 CERTIFICATE CERTIFICATE ISSUED TO • ISSUED BY • ALEXANDER & ALEXANDER, INC. • CITY HALL 3550 WILSHIRE BOULEVARD • CITY OF HUNTINGTON BEACH HUNTINGTON BEACH, CALIFORNIA LOS ANGELES, CALIFORNIA 90010 HOLLAND-AMERICA INSURANCE COMPANY and/or MISSION INSURANCE COMPANY and/or SAYRE AND TOSO, INC. has issued coverage effective as of the dates and for the periods and limits specified below and subject to all terms, conditions, provisions, exclusions and limitations of the described Binders or Policies whether shown by endorsement or otherwise. Any requirements or provisions in any contract or agreement between the Insured and any other person, firm or corporation will not be construed as enlarging, altering or amending the definition of insured or any other terms or conditions of this certificate or the policy designated. KIND OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY COMPENSATION EFF STATUTORY CALIFORNIA COMPENSATION WORKMEN'S COMPENSATION EXP COMPENSATION EFF STATUTORY COMPENSATION STATE(S) OF WORKMEN'S COMPENSATION EXP EMPLOYER'S LIABILITY $ PER OCCURRENCE LIABILITY EACH PERSON EACH OCCURRENCE BODILY INJURY LIABILITY AUTOMOBILE $ EACH PERSON $ EACH OCCURRENCE BODILY INJURY LIABILITY EXCEPT AUTOMOBILE HAC 11202 EFF 7/1/71 $ 500,000. SINGLE LIMIT PROPERTY DAMAGE LIABILITY EACH OCCURRENCE BODILY INJURY & AUTOMOBILE EXP 7/1/72 $ PROPERTY DAMAGE COMBINED PROPERTY DAMAGE LIABILITY EACH OCCURRENCE AGGREGATE EXCEPT AUTOMOBILE $ $ AUTOMOBILE PHYSICAL DAMAGE COMPREHENSIVE EFF $ FIRE, LIGHTNING & TRANSPORTATION $ THEFT (BROAD FORM) EXP $. COLLISION OR UPSET ACTUAL CASH VALUE LESS $ DEDUCTIBLE "THIRD PARTY PROPERTY DAMAGE EFF EXP $ UMBRELLA EXCESS POLICY EFF EXP $ Effective any loss under Physical Damage Coverage is payable as interests may appear to the Named Insured and the Lienholder named below in accordance with Loss Payable Endorsement on reverse side. LIENHOLDER • As respects the following described automobile(s): YEAR TRADE NAME BODY TYPE AND MODEL SERIAL NUMBER' DESCRIPTION AND LOCATION OF OPERATIONS "OTHER THAN AUTOMOBILE This policy shall not be canceled nor reduced in coverage until after30 days written notice of such cancelation or reduction in coverage shall have been mailed to this certificate holder. Certified this 17th day of JUNE 19 71 IN HOLLAND-AMERICA INSURANCE COMPANY ❑ MISSION INSURANCE COMPANY ❑_$AYRE & TOSO Producer BY AuthorizedKKre entative H A c 3(10-70) BALTIMORE � ` �'�`ti�� ' i� ail •�� `°!SO PITTSBURGH NEW YORK I N C.O R P O R AT E D SAN FRANCISCO CLARKSBURG NEW ORLEANS ST.LSA LOUIS INSURANCE HIILADELPHIA CHICAGO TORONTO LOSANGELES AVERAGE ADJUSTERS CONSULTING ACTUARIES MONTREAL ATLANTA 3550 WILSHIRE BOULEVARD LOS ANGELES, CALIF. 90010 NEWARK TELEPHONE (213( 385-5211 CABLE ADDRESS ''ALEXLOS" June 17, 1971 City Hall City of Huntington Beach Huntington Beach, California Gentlemen: SCHAEFER'S AMBULANCE SERVICE, INC. , ET AL EVIDENCE OF INSURANCE In accordance with our Insured's request, enclosed is a Certificate of Insurance, effective July 1, 1971, which has been .issued by the Holland- America Insurance Co. Verb truly yours, Frank D. Nicholl, Jr. , Manager Casualty Department FDN:rs encl. ALEXANDER & ALEXANDER THE TRAVELERS HARTFORD, CONNECTICUT LXJ CANCELLATION NOTICE. Please take notice that the Policy designated below, heretofore issued to the insured named below, has been canceled, such cancellation being effective on the date stated below. ❑ NOT TAKEN NOTICE. Please take notice that the Insured named below has not accepted the Policy designated below and therefore no insurance has come into force thereunder. ❑ AMENDMENT NOTICE. Please take notice that, effective on the date stated below, the Policy designated below has been amended as follows: WRITTEN NOTICE IS HEREBY THE PERSON TO WHOM AN INSURANCE AN ADDITIONAL INSURED UNDER A BANK OR GIVEN TO YOU AS: CERTIFICATE WAS ORIGINALLY ISSUED; ❑ THE TERMS OF THE POLICY; ❑ A MORTGAGEE; ❑ FINANCE COMPANY. INSURED ISSUING OFFICE SCHAEFERIS AMBULANCE SERVICE, INC. ET AL L A-IQ5 POLICY NO. EXTENSION CERTIFICATE NO. EFFECTIVE DATE OF THIS NOTICE DATE ISSUED NSL-6561943 7-1-71 5 7-71 LOCATION (Complete for Fire Policies ONLY) THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY CITY HALL THE CHARTER OAK FIRE INSURANCE COMPANY CITY OF HUNTINGTON BEACH HUNTINGTON BEACH, CALIFORNIA President L J C-5358 REV.7-67 PRINTED IN U.S.A. 668 II � • THE TRAVELER? Certificate of Insurance This is to certify that policies of insurance as described below have been issued to the insured named below and are in force at this time. If such policies are canceled or changed during the periods of coverage as stated herein, in such a manner as to affect this certificate, written .notice will be mailed to the party designated below for whom this certificate is issued. 1. Name and address of party to whom this certificate is issued 2. Name and address of insured I— CITY HALL- Schaefer's Ambulance Service, CITY OF HUNTINGTON BEACH Inc., , Et Al HUNTINGTON BEACH, CALIFORNIA 4631 Beverly Boulevard Los Angeles, California 90004 L J 3. Location of operations to which this certificate applies 4. Coverages For Which Insurance is Afforded Limits of Liability Policy Number Policy Period" Workmen's Compensation and Employers'Liability Compensation—Statutory ' in the state named in item 3 hereof Bodily Injury Liability—except automobile ' $ 100,OQO, each person $ 300,000, each accident NSL- 5-1-1971 in cluding Protective S . 300,000. each occurrence 6561943 TO ---- ---------------------------------------------------------- ----------------------------------------------- Property Damage Liability—except automobile Until $ 50,000. each accident Cancelled S 50,000. each occurrence in cluding Protective $ 50,000. aggregate Bodily Injury Liability—automobile ° $ 100.0000. each person $ 300,000, each accident $ each occurrence ------------------------------------------------------------------ ------------------------------------------------ s Property Damage Liability—automobile ~ 50,000. � each accident $ $ each occurrence Liability (Bodily Injury and Property Damage) IS each accident ' $ each occurrence _ *Absence of an entry in these spaces means that insurance is not afforded with respect to the coverages opposite thereto. "Policy is effective and expires at 12:01 A.M., standard time at the address of the named insured as stated herein. Description'of Operations, or Automobiles to which the policy applies: The insurance afforded is subject to all of the terms of the policy, including endorsements, applicable thereto. THE TRAVELERS INSURANCE COMPANY Office Los Angeles, Cali forni a THE TRAVELERS INDEMNITY COIAPANY THE CHARTER OAIC FIRE INSURANCE COMPANY 7 Producer_ ALEXANDER & AL NDER ALEXA & ALE DER _ Date April pri ' �� By ut sized Re resertalive C-5918 REV.11-66 PRINTED in U.S.A. p THE TRAVELER? Certificate of Insurance This is to certify that policies of Insurance as described below have been issued to the insured named below and are in force at this time. If such policies are canceled or changed during the periods of coverage as stated herein, in such a manner as to affect this certificate, written .notice will be mailed to the party designated below for whom this certificate is issued. 1. Name and address of party to whom this certificate is issued 2. Name and address of insured Schaefer's Ambulance Service, CITY HALL: Inc.. , Et Al CITY OF HUNTINGTON BEACH 4631 Beverly Boulevard HUNTINGTON BEACH, CALIFORNIA Los Angeles, California 90004 L -J 3. Location of operations to which this certificate applies 4. Coverages For Which Insurance is Afforded Limits of Liability Policy Number Policy Period** Workmen's Compensation and Employers'Liability Compensation—Statutory in the state named in item 3 hereof Bodily Injury Liability—except automobile $ 100,000, each person $ 300,000. each accident NSL- 5-1-1971 in cluding Protective S 300,000. each occurrence 6561943 TO ----------------------------------------------------------------- --------------- ------------------------------- Property Damage Liability—except automobile Until $ 50,000. each accident Cancelled $ 50,000. each occurrence in cluding Protective $ 50,000. aggregate Bodily Injury Liability—automobile ° $ 100,000, each person $ 300,000, each accident $ each occurrence ------------ ----------------------------------------------------- ------------------------------------------------ Property Damage Liability—automobile ° $ 50,000, each accident _$ each occurrence Liability (Bodily Injury and Property Damage) $ each accident $ each occurrence *Absence of an entry in these spaces means that insurance is not afforded with respect to the coverages opposite thereto. **Policy is effective and expires at 12:01 A.M., standard time at the address of the named insured as stated herein. Description"of Operations, or Automobiles to which the policy applies: The insurance afforded is subject to all of the terms of the policy, including endorsements, applicable thereto. THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY Office Los Ans e1es, California THE CHARTER OAK FIRE INSURANC COMPANY Producer ALEXANDER & AL ANDF.R ALEXA F & A-M ER April--Z9 r l�'71 Date $y C-5918 REV.11-60 PRINTED IN U.S.A. 1!f/ari M presentative ♦ � w 0 BALTIMORE PITTSBURGH NEW YORK I N C O R P O R A T E D SAN FRANCISCO CLARKSBURG NEW ORLEANS STLLOUIS I NSURANCE PHILADELPHIA CHICAGO TORONTO LOSANGELES AVERAGE ADJUSTERS CONSULTING ACTUARIES MONTREAL ATLANTA 3550 WILSHIRE BOULEVARD LOS ANGELES, CALIF. 90010 NEWARK TELEPHONE (213) 385-5211 CABLE ADDRESS ''ALEXLOS'' April 29, 1971 City Hall City of Huntington Beach Huntington Beach, California GENTLEMEN: SCHAEFER'S AMBULANCE SERVICE, INC., ET AL EVIDENCE OF INSURANCE In accordance with our Insured's request, enclosed is a Certificate of Insurance, effective May lst, 1971, which has been issued by the Travelers Insurance Company. Very truly yours, ALEXANDER & ALEXANDER Frank D. Nicholl, Jr. , Manage - Casualty Department FDN:ep Encl. YOSEt�'iITE INSURANCE COMPANY 717 Market Street San Francisco, Calif. 94103 NOTICE OF CANCELLATION OF INSURANCE POLICY TO ALL INSURF-DS(S), MORTGAGEES, AND LOSS PAYEES NAMED IN THE POLICY DESCRIBED BELOW: The Yosemite Insurance Company serves this notice of cancellation in accordance with the stipulations and provisions in the printed conditions of the below described policy issued to you. Take notice, therefore, that all liability of the Yosemite insurance Company under said policy to you will cease and be terminated at 12:01 a.m. Standard Time ten (10) days from date of this notice as provided in said policy. The excess of paid premium over the pro-rata earned premium will be refunded in accordance with the provisions of the policy. Named r Insured GOLD AMBULANCE SERVICE, INC. or p.o. box 518 REASON.FOR CANCELLATION Purchaser LAGUNA BEACH, CALIFORNIA 92652 if Single Interest Non-Payment Policy , - J FPOLICY CA 463881 NUMBER 1- OF NOTICE ether r 55 71 Policy Issued M. B. BUETTNER CO. through C/o ALLEN T. ARCHER CO. (Agent) 3200 WILSHIRE BLVD. LOS ANGELES, CALIFORNIA L YOSEMITE INSURANCE COMPANY r CITY OF HUNTINGTON BEACH CITY HALL HUNTINGTON BEACH, CALIFORNIA . A -------- ------------------------. ... Authorized Represjj;:�ative YIC-15A ASSURED COPY Allaim ® \ i )Co). I N C O R P O R A T E D Insurance OFFICES 3200 WILSHIRE BOULEVARD ANC H ORAGE•CHICAGO Los Angeles, California 90005 - CORRESPONDENTS H 0USTON•LOS ANGELES PRINCIPAL CITIES SAN FRANCISCO•SEATTLE TELEPHONE(213)385-2861 • TELEX 677-136 U.S A.AND CANADA December 28, 1970 City of Huntington Beach City Hall Huntington Beach, California Gentlemen: You will find enclosed: ❑ Policy as requested. ❑ Endorsement which should be attached to your policy. ❑ Renewal policy continuing coverage on same terms and conditions. ❑ Certificate copy of policy the original having been sent to the mortgagee. ❑ Loss Payable Endorsement. ❑ Duplicate copy of policy. ❑ Certificate of Insurance as requested. x❑ Certificate of Insurance. This replaces Policy #105530, Cert. #165, which will expire January 1, 1971. Very truly yours, ALLEN T. ARCHER CO. eh/DMA/s E.Hoss enc. CC: Gold Ambul Sery IE £ 1, b CERTIFICATE OF INSURANCE . CITY OF HUNTINGTON BEACH CITY HALL HUNTINGTON BEACH,CALIFORNIA NAME OF INSURED . GOLD AMBULANCE SERVICE,INC. ADDRESS P.O.BOX 518 LAGUNA BEACH, CALIFORNIA 92652 THIS IS TO CERTIFY AS TO THE EXISTENCE OF INSURANCE WITH YOSEMITE INSURANCE COMPANY AND/OR HARBOR INSURANCE COMPANY AS DESCRIBED BELOW: AUTOMOBILE KIND OF INSURANCE LIABILITY INCLUDING MALPRACTICE LIABILITY POLICY NO. CA 463881 EFFECTIVE FROM: 11-16-70 TO: UNTIL CANCELLED LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $10,000.00 COMBINED SINGLE LIMIT LIABILITY BY �d- KIND OF INSURANCE EXCESS BODILY INJURY LIABILITY AND PROPERTY DAMAGE LIABILITY POLICY NO. 109960 — CERT. 129 EFFECTIVE FROM: 1-1-71 TO: 1-1-74 LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $ 490,000. COMBINED SINGLE LIMIT EXCESS OF LIABILITY $10,000.00 COMBINED SINGLE LIMIT. THE COMBINATION OF THIS CERTIFICATE WITH THE YOSEMITE INSURANCE COMPANY POLICY GIVES A TOTAL OF $500,000. COVERAGE APPLICABLE TO ANY BODILY INJURY LOSS, TO ANY PROPERTY DAMAGE LOSS OR TO ANY LOSS INVOLVING BOTH TYPES OF COVERAGES IN ANY ONE POLICY YEAR. J 2 BY 4 - 7 • SHOULD THE ABOVE MENTIONED POLICY OR CERTIFICATE BE CANCELLED, ASSIGNED OR CHANGED IN SUCH MANNER AS TO AFFECT THIS POLICY, WE WILL GIVE TEN (10) DAY WRITTEN NOTICE TO THE ABOVE NAMED HOLDER OF THIS CERTIFICATE. Dated at LOS ANGELES 90005 , CALIFORNIA this 28TH day of DECEMBER, 1970 ALIEN T. AISCIIER Co. 3200 WILSHIRE BLVD.-LOS ANGELES 90005 TELEPHONE 385-2861 NOTICE OF CANCELLATION OF INSURANCE POLICY To all Insureds, Mortgagees, and Loss"ayees, if any,,named in the policy,rdescribecl bel-AA:: ' II X _....._- ' � You are herebynotified that the said G in its entiret p � - y including any mortgagee or ,.,., payable clause, is canceled as to all interests insured,at 12 9,1 A.M.Standard Time, on the date shown below. b Premium adjustment: If premium for said policy has not been paid,the earned premium due and payable shall be computed as provided in the policy, and demand is hereby made for 0 SIGNAL INSURANCE COMPANY payment thereof. If premium has been paid,the excess paid premium,-if any, above the Fft IMPERIAL INSURANCE COMPAN earned premium, if not tendered with this cancellation notice,will be refunded as soon as ,,,,_, practicable after cancellation becomes effective. Ai1THOR'IZED REPRESENT ATIVY POLICY NUMBER EFFECTIVE DATE OF CANCELLATION a DATE REASON FOR CANCELLATION (SEE REVERSE FOR EXPLANATION OF CODE) O , ah � • Zlog "ddij *Jty hereby certify,or declare,under the penalties of perjury,that on the postmarked Z date I personally mailed in a United States Post Office, a Notice Of Cancellation w 3= jlii,lobl" 1 Of Insurance Policy,in a sealed envelope with proper postage prepaid addressed to O each of the addresses exactly as shown on this page; and at the, same time— d �Q1 requested and received'a Postal Receipt for each such mailing, which is a part L hereof. (Signature) w _ 01'elt ' $each f :it)r of Zms Beach � L L Att. Mr. PblISMW SI 100D (11/68) i (APPLICABLE TO THE STATE OF CALIFORNIA ONLY) 1. During the 60 days following original issue,the risk is unacceptable to the insurer. Any such cancellation is necessarily sub- ject.to the provisions of Section 11628 of the California Insurance Code. 2. The named insured fails to discharge when due any of his obligations in connection with the payment of premiums for the policy,or any installment therefor. 3. - The driver's license or the motor vehicle registration of the named insured or of any other operator who either resides in the same household or customarily operates an automobile insured under the policy has been under suspension or revoca- tion during the policy period. I You are permitted by law to appeal this cancellation. Appeal should be filed.before-the effective date of cancellation set forth in. this notice. Forms for such appeal and the regulations pertaining thereto may be obtained from the offices of the Insurance Commissioner in San Francisco or Los Angeles.. Appeals must be accompanied by a deposit.. You or this Company may be i charged with the costs of the appeal, depending on the outcome. Pursuant to Section 652 of the California Insurance Code, you are hereby notified that: "1. The California Automobile Assigned R isk Plan provides a means by which applicants for automobile bodily injury and property damage liability insurance may be assigned to an insurer authorized to transact liability insurance. 2. ` If you are unable to procure such insurance through ordinary methods and you are in good faith eligible for such insur- ance in accordance with the standards of the Plan, it is possible for you to obtain it through the Plan. 3. Application forms for insurance through the Plan may be obtained from and submitted through (a) any licensed insurance agent or broker, or (b) the Plan itself at 215 Market Street, San Francisco 94105, or 3750 West Sixth Street, Room _ 104, Los Angeles 90005." (APPLICABLE TO THE STATE OF WASHINGTON ONLY) 4. During the 60 days following original issue,the Risk is unacceptable to the insurer. 5. The named insured fails to discharge when due any of his obligations in connection with the payment of premiums for the policy,or any installment therefor;',, 6.- The driver's license of the named insured or.of any other operator who-either resides in the same household or customarily operates an automobile insured under the policy has been under suspension or revocation during the policy period. 7. The named insured.or any other operator-who customarily operatesan automobile insured under the policy has experienced and is likely to experience epilepsy or heart attacks,and such individual cannot produce a certificate from a physician-testi- fying to his unqualified ability to operate a motor vehicle. 8. The named insured or any other-operator who customarily operates-an-automobile insured under the policy is or has.been convicted of or forfeits bail during the thirty-six-months immediately preceding the effective date of the policy or,during the policy period;for l (i) any felony,or (ii) criminal negligence resulting in death, homicide,or assault,arising out of the operation of a motor vehicle,or: (iii) operating a motor vehicle while in an intoxicated condition or while under-the influence of drugs, or " (iv) leaving the scene of an a ant without stopping to report,or (v) a third,violation.for any oT e_operator within a period of eighteen months or-any moving traffic.'offense. I NOTICE,OF REINSTATEMENT NSURANCE POLICY To all Insy-reds, Mortgagees,and Loss Payees, if any, named in the policy described below: You are hereby.notified that the said policy, canceled on the date shown below, is hereby reinstated at 12:01 A.M. Standard Time on the date shown below, and 0 SIGNAL INSURANCE COMPANY in consideration of such reinstatement, it is expressly stipulated that there shall be IMPERIAL INSURA NCE COMPANY no coverage under said policy for any loss occurring between the cancellation date ` and the effective date of reinstatement. ffAUTHORIZED RfPRESE`NTATIVE POLICY NUMBER EFFECTIVE DATE OF CANCELLATION EFFECTIVE DATE OF REINSTATEMENT December 179 1970 o F W En � r a L 4J F MA"'f'LEfFR M a L awltitstm fto�b, City tml&jkmft, � N Ru .. . so n1m SI 101B (miss) MORTGAGEE'S COPY I i f i i i I 1 i r� I N C O R P O R A T E D Insurance oFFlces 3200 WILSHIRE BOULEVARD ANCHORAGE-CHICAGO Los Angeles, California, 90005 CORRESPONDENTS HO USTON.LOS ANGELES PRINCIPAL CITIES SAN FRANCISCO•SEATTLE TELEPHONE(213)385-2861 • TELEX 677-136 U.S.A.AND CANADA. November 18, 1970 City of Huntington Beach City Hall Huntington Beach,' California. i I Gentlemen: You will find enclosed: ❑ Policy as requested. ❑ Endorsement which should be . attached to your policy. ❑ Renewal policy continuing coverage on same terms and conditions. ❑ Certificate- copy.of. policy the original having been sent to the mortgagee. ❑.Loss Payable Endorsement. . ❑ Duplicate copy of. policy. ❑ Certificate of Insurance as requested.' ®Certificate of Insurance. ZV Very truly yours, ALLEN T. ARCHER CO. eh/DMA/s E. Hoss enc. CC: Gold Ambul Sery .',. z3 _> CERTIFICATE 'OF INSURANCE CITY OF. HUNTINGTON BEACH CITY HALL HUNTINGTON BEACH, CALIFORNIA NAME OF INSURED . GOLD AMBULANCE SERVICE, INC. ADDRESS P.O. BOX 518 — LAGUNA BEACH, CALIFORNIA 92652 THIS IS TO CERTIFY AS TO THE EXISTENCE OF INSURANCE WITH YOSEMITE INSURANCE COMPANY _ AND/OR HARBOR INSURANCE COMPANY AS DESCRIBED BELOW: AUTOMOBILE KIND OF INSURANCE LIABILITY INCLUDING MALPRACTICE LIABILITY POLICY NO. CA 463881 EFFECTIVE FROM: 11-16-70TO:UNTIL CANCELLED LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE. $10,000.00 COMBINED .SINGLE LIMIT LIABILITY BY . KIND OF,INSURANCE EXCESS BODILY INJURY LIABILITY AND PROPERTY'DAMAGE LIABILITY .' POLICY NO. 105530 - Cert. #165 EFFECTIVE FROM: 11-16-70 TO:1-1-71 LIMITS: BODILY INJURY LIABILITY AND/OR PROPERTY DAMAGE $ 490,000.00 COMBINED.SINGLE LIMIT EXCESS OF LIABILITY $10,000.00 COMBINED SINGLE LIMIT. THE COMBINATION OF THIS CERTIFICATE WITH THE YOSEMITE INSURANCE COMPANY POLICY GIVES A TOTAL OF $500P-000. COVERAGE APPLICABLE TO ANY BODILY INJURY LOSS, TO ANY PROPERTY DAMAGE LOSS OR TO ANY LOSS INVOLVING BOTH TYPES OF COVERAGES IN ANY ONE POLICY YEAR. BY W tt tv SHOULD.THE ABOVE MENTIONED POLICY OR CERTIFICATE BE CANCELLED; ASSIGNED OR CHANGED IN SUCH MANNER AS TO AFFECT THIS POLICY, WE WILL GIVE,TEN (10)'DAY WRITTEN NOTICE TO THE ABOVE NAMED HOLDER OF THIS CERTIFICATE. Dated at LOS ANGELES 90005 , CALIFORNIA this 18TH day of NOVEMBER, 1970 ALLEN T. ANICIIEIi CO. 3200 WILSHIRE BLVD.•LOS ANGELES 90005 TELEPHONE 385-2861 z3 0 CERTWICATE OF INSURANCE 0 4/ NAMED andURED SCHAEFER'S AMBULANCE SERVICE., INC. et al ADDRESS 4631 B' 'RLY BLVD. c000amuymmffT LOS ANGELES, CALIFORNIA . 90004 CERTIFICATE ISSUED TO CMTZ BALL . CITY OF HMINGTON BEACH HUNTINGTON BEACHP CALIFORM THIS IS TO CERTIFY THAT THE COMPANY INDICATED BELOW HAS ISSUED TO THE INSURED NAMED HEREIN, COVERAGE EFFECTIVE AS OF THE DATES AND FOR THE PERIODS AND LIMITS SPECIFIED BELOW AND SUBJECT TO ALL TERMS, CONDITIONS, PROVISIONS, EXCLUSIONS, AND LIMITATIONS OF THE DESCRIBED BINDERS OR POLICIES WHETHER SHOWN BY ENDORSEMENT OR OTHERWISE. ANY REQUIREMENTS OR PROVISIONS IN ANY CONTRACT OR AGREEMENT BETWEEN THE INSURED AND ANY OTHER PERSON,FIRM,OR CORPORATION WILL NOT BE CONSTRUED AS ENLARGING,ALTERING,OR AMENDING THE DEFINITION OF INSURED OR ANY OTHER TERMS OR CONDITIONS OF THIS CERTIFICATE OR THE POLICY DESIGNATED. KIND OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY COMPENSATION STATUTORY CALIFORNIA COMPENSATION WORKMEN'S COMPENSATION EMPLOYER'S LIABILITY--$500,000 PER OCCUR. COMPENSATION STATUTORY COMPENSATION STATE(S)OF WORKMEN'S COMPENSATION 7/1/70 CAUFORM W 88- EMPLOYER'S LIABILITY—$ PER OCCUR. LIABILITY EACH PERSON EACH OCCURRENCE BODILY INJURY LIABILITY- 5 1 70 AUTOMOBILE GIA905259_ -1 $ loo.000 $ BODILY INJURY LIABILITY- EACH PERSON EAC OCC RRENCE EXCEPT AUTOMOBILE $ $ PROPERTY DAMAGE LIABILITY- EACH OCCURRENCE AUTOMOBILE PROPERTY DAMAGE LIABILITY- EACH A OCCURRENCE ;� 66REGATE EXCEPT AUTOMOBILE $ $ AUTOMOBILE PHYSICAL DAMAGE COMPREHENSIVE * ACV LESS$ �, DEDUCT. COLLISION OR UPSET * LESS$ 100. DEDUCT. INLAND MARINE $ *,ABSENCE OF ENTRY MEANS"ACTUAL CASH VALUE". EFFECTIVE ANY LOSS UNDER PHYSICAL DAMAGE COVERAGES WITH RESPECT TO THE AUTOMOBILE(S) DES- CRIBED BELOW IS PAYABLE AS INTEREST MAY APPEAR TO THE NAMED INSURED AND: LOSS PAYEE • FORM 49-A(ON REVERSE) IS HEREBY INCORPORATED. YEAR TRADE NAME BODY TYPE MODEL IDENTIFICATION/SERIAL NUMBER DESCRIPTION AND LOCATION OF OPERATIONS: IN THE EVENT OF MATERIAL CHANGE IN OR CANCELLATION OF ANY OF SAID POLICIES,THE COMPANY WILL ENDEAVOR TO GIVE WRITTEN NOTICE THEREOF BY REGULAR MAIL TO THE PERSON OR ORGANIZATION AT WHOSE REQUEST THIS CERTIFICATE IS ISSUED, BUT THE COMPANY SHALL NOT BE LIABLE FOR FAILURE TO GIVE SUCH NOTICE,NOR FOR ANY ERROR. AGENT OR -^ '4 SIGNAL INSURANCE COMPANY BROKER FOR ALL YOUR INSURANCE NEEDS ® IMPERIAL INS ANCE COMPANY HARRY A. BRAMWELL CO. DATE D ZI 3200. WILSHIRE BLVD. PHONE DUNKIRK B-4171 LOS, ANGELES. 5, CALIF. BY y__//j m/41pz'w ale SI 181B (4/69) � AUTH AIZED REPRESENTATIV I :-3-, =- —4bTOMOBILE LOSS PAYABLE ENDORSEMENT,-IFORM 44-A With respect to the interest of the loss payable, its successors and assigns (hereinafter called the Lien-Holder), in its capacity as conditional Vendor or Mortgagee or otherwise, in the property insured under this policy, this Company hereby agrees as follows: Loss or damage, if any, to the property described in this policy shall be payable firstly to the Lien-Holder and secondly to the insured, as their interests may appear, provided nevertheless that upon demand by the Lien-Holder upon the Company for separate settlement the amount of said loss shall be paid directly to the Lien-Holder to the extent of its interest and the balance, if any, shall be payable to the insured. The insurance under this policy as to the interest only of the Lien-Holder shall not be impaired in any way by any change in the title or ownership of the property or by any breach of warranty or condition of the policy, or by any omission or neglect, or by the performance of any act in violation of any terms or conditions of the policy or because of the failure to perform any act required by the terms or conditions of the policy or because of the subjection of the property to any conditions, use or operation not permitted by the policy or because of any false statement concerning this policy or the subject thereof, by the insured or the insured's employees, agents or representatives; whether occurring before or after the attachment of this agreement, or whether before or after the loss; PROVIDED, however, that the wrongful conversion, embezzlement or secretion by the Purchaser, Mortgagor, or Lessee in possession of the insured property under mortgage, conditional sale contract, lease agreement, or other contract is not covered under this policy unless specifically insured against and premium paid therefor. In the event of failure of the insured to pay any premium or additional premium which shall be or become due under the terms of this policy, this Company agrees to give written notice to the Lien-Holder of such non-payment of premium after sixty (60) days from and within one hundred and twenty (120) days after due date of such premium and it is a condition of the continuance of the rights of the Lien-Holder hereunder that the Lien- Holder when so notified in writing by this Company of the failure of the insured to pay such premium shall pay or cause to be paid the premium due within ten (10) days following receipt of the Company's demand in writing therefor. If the Lien-Holder shall decline to pay said premium or additional pre- mium, the rights of the Lien-Holder under this Automobile Loss Payable Endorsement shall not be terminated before ten (10) days after receipt of ,said written notice by the Lien-Holder. If the Company elects to cancel this policy in whole or in part for non-payment of premium, or for any other reason, the Company will forward a copy of the cancellation notice to the Lien-Holder at its office specified hereinafter concurrently with the sending of notice to the insured but in such case this policy shall continue in force for the beneff of the Lien-Holder only for ten (10) days after written notice of such cancellation is received by the Lien- Holder. In no event, as to the interest only of the Lien-Holder, shall cancellation of any insurance under this policy covering the property described in the policy be effected at the request of the insured before ten (10) days after written notice of request for cancellation shall have been given to the Lien-Holder by the Company. In the event of cancellation of this policy the unearned premium shall be paid to the Lien-Holder, provided the said Lien-Holder has advanced the premium. If there be any other insurance upon the within-described property, this Company shall be liable under this policy as to the Uen-Holder only for the proportion of such loss or damage that the sum hereby insured bears to the whole amount of valid and collectible insurance of simiiaT,character on said property under policies held by, payable to and expressly consented to by the Lien-Holder, and to the extent of payment so made this Company shall be subrogated (pro rota with all other insurers contributing to said payment) to all of the. Lean-Holder's rights of contribution under said other insurance. Whenevert this Company shall pay to the Lien-Holder any sum for loss or damage under this policy_;gnd sl`al3 claim that as to=the insardd no liability therefor exists, this Company at its option, may pay to the Lien-Holder the whole principal sum and interest due or to become due from the insured on the obligation secured by .the property insured under this policy (with pro rafa refund of all int1rest not accrued to date of last installment paid), and this Company shall thereupon receive a full assignment and transfer, without recourse, of said �biigation•and the security h@d•as oollhteral thereto; but no subrogation shall impair the right of the Lien-Holder to recover the full amount of its claim, The coverage granted under this policy shall continue in full force and effect as to the interest th®.Lieln-Holder only, for a_ peribd,,?f.fen (10) days after expiration of said policy unless an acceptable policy in renewal thereof with loss thereunder �Slay�ble' to the Lien-Holdif"i� acco�dance with the terms of this Automobile Loss Payable Endorsement shall have been issued by some insurance company and accepted by the Lien-Holder. In the event of a loss not otherwise covered during the exten er�jJ t�a�y period-herein referred to, an agnuahea licy covering the same •ha"r S Jts6 the property insured under the original policy shall be issued ace d 15y the Lferltibls�er and Mortgagor:' ` Should the ownership and right of possession of any of the property cored\under this policy become vested in the Lien-Holder or its agent, this policy shall continue for the term thereof for the benefiC,'of the..Lien f-holder ,(w�ii all incidents of ownership of the policy) but in such event, Paragraphs two (2), five (5) and six (b) of this Automobile Loss Payable Endorsement,sQ1,no longer apply;-prtovi ?d; nevertheless, all privileges and endorsements which, by reason of the printed conditions of this policy, are or may be Ae"cVssary-to maintain the validify'of'the contract are hereby granted for a period of thirty (30) days and all notices likewise required to be given to the Company by the insured are hereby waived for a period of thirty (30) days with the exception of requirements applying at the time of or subsequent to a loss. All notices herein provided to be given by the Company to the Lien-Holder in connection with this policy and this Automobile Loss Payable Endorsement shall be mailed to or delivered to Lien-Holder at its address in policy. This endorsement is subject to all of the terms and provisions of the policy, which are not inconsistent. •_I__l Ll .�_•_ _ �1T1__ _,:J -J. -1 •._ I;:'_i,, , _ .�� GI �J c U.S.POSTAGE Barry A. Bramwell Co. general insurance 3200 WILSHIRE BLVD. LOS ANGELES, CALIF. 90005 ,1'J ,- .-FRANKLIN D.ROOSEVELT4 City of Huntington Beach City Hall Huntington Beach, Calif. 92646 d