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Home My WebLink AboutHUNTINGTON BEACH UNION HIGH SCHOOL DISTRICT - Certificate of f '-RETURN OJPSIN4L AND VR EE.0 O�JES 0P ONLY CITY OF HUNTING?ON OEA'C"4'FORM ` .CT"31VIPLET£D CERTIFICATE TO: s CERTIFICATE OF INSURANCE r OF CERTIFICATE .OF INSURANCE WILL BE ACCEPTED. CITY OF HUNTINGTON BEACH TO P.O. AOXJI90 CITY OF HUNTINGTON BEACH, CALIFORNIA HUNTINGTON BEACH, CALIFORNIA 92646 A MUNICIPAL CORPORATION This is to certify that the policies of insurance as described below have been issued to the insured by the under- signed and are in force at this time. If these policies are cancelled or changed in such a manner that will affect this certificate, the insurance company agrees to give 30 days prior written notice, by mail, to City of Huntington Beach, P.O. Box 190, Huntington Beach, California 92648. Name of Insured HUNTINGTON BEACH UNION HIGH SCHOOL DISTRICT 1902'21STINTENTE STBEBT Address Of Insured_ INGTON BEACH, CALIFORNIA Location of Insured Operations ]MINf3TON BRACRe CALIFOFAU Description of Operations AIM SCHOOL DISTBIGT s POLICIES IN FORCE POLICY DATE LIMITS OF LIABILITY NUMBER EFFECTIVE EXPIRATION A. Workmen's Compensation Statutory Employers' Liability STATE OF CALIF RNIA $ B. Public Liability: * $1,000,000 combined single Bodily Injury: PS5684+ 18 7/1/7 UNTIL limit per occurrance. Manufacturers and CANCELLED Contractors $900 * 000 Each Person Comprehensive General ® $2,OOC 000 Each Accident (Including products completed operations) Property Damage $ 100* 000 Each Accident C. Automobile Liability: Bodily Injury PS5684 18 7/1/7L UNTIL $500 * 000 Each Person CANCELLED $2,00-0 000 Each Accident Property Dwhaga $2,00£} 000 Each Accident Does policy cover: All owned automobiles ( X ) Yes ( ) No `Non-owned automobiles ( X ) Yes ( ) 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 groups,committees, commissions,boards and any other City Council appointed body,and/or elective and appointive officers,servants or employees of the City of Huntington Beach,when acting as such are additional assureds'hereunder. E. H614 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 of action 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 to any insurance of the city. F. Minimum Limits Required; Combined Single Limit Bodily Injury and/or Property Damage including Products Liability: $1,000,000 combined single limit per occurrence. E & 0 LIMITS 100f300 REP= TO ATTACHED CERTIFICATE,_FT", AX*S EL121T VOLICI XT 10:520 26 X H PROVIDES EXCE1gS LIABILITY COVERAGE TO 11OOO,000 COMBI1XD SINGLE LIB`S. Date FaUARY 10, 1975 COMPANY REPRESENTATIVE Name e CL C•OM pF THE PACI1KC Insurance—Gompp$'ny COAST SIGNATURE OF AUTHORIZED REPRESENTATIVE Agent Address620 "N PORT CENTER DRIVE, Address 620 NEWPORT CENTER DRIVE. NEWPORT r, ,x BEACH CALIFORNIA City NEWPORT BEAC11, ,,CALIFORNIA Telephone 644-8550 APPROVED AS TO s . DON P. Bum -City ttorngy a • �,.� ' 'AFTURN ORIGINAL AND THREE COPIES 01 � ONLY CITY OF HUNTINGTON DEACN'J'FORM C OMPL F.TLO CERTIFICATE TO: CERTIFICATE OF INSURANCE OF CERTIFICATE OF INSURANCE WILL ■E _ ACCEPTED. CITY OF HUNTINGTON PEACH TO P.O. BOX 190 CITY OF HUNTINGTON BEACH, CALIFORNIA HIINTINGYON BEACH, CALIFORNIA 92648 A MUNICIPAL CORPORATION This is to certify that the policies of insurance as described helow have been issued to the insured by the under- signed and are in force at this time, If these policies are cancelled or changed in such a manner that will affect this certificate, the insurance company agrees to give 30 days prior write n notice, by mail, to City of Huntington Beach, P.O. Box 190, Huntington Beach, California 92648. Name of Insured HUNTINGTON BEACH UNION HIGH SCHOOL DISTRICT 1902 SEVENTEENTH STREET Address of Insured HUNTIINGTON BEACH, CALIFORNIA Location of Insured Operations HUNTINGTON BEACH, 'CALIFORNIA Description of Operations HIGH SCHOOL DISTRICT — POLICIES IN FORCE POLICY DATE LIMITS OF LIABILITY NUMBER EFFECTIVE EXPIRATION_ _ A. Workmen's Compensation i — i Statutory Employers' Liability STATS' OF CALIF RNIA $_ B. Public Liability: * $1,000,000 combizned single Bodily Injury: PS5Ei84' lv 7/1/7 UNTIL limit per occ'<:zrance. j Manufacturers and CANCEMLED Contractors $50 i *.O0C' Each Person Comprehensive General ® $2,0(-*J O00 Each Accident (Including products completed operations) Property Damage $ 1O0* OOO Each Accident C. Automobile Liability: Bodily Injury PS5684 '18 7/J/'7Lr UNTIL $1_)O * 000 Each Person CANCELLED $2 ,00>) COO Each Accident Property Damage $2,0..?k-_C?�0 Each Accident Does policy cover: All owned automobiles ( X ) Yes ( ) No Non-owned automobiles ( ) Yes ( ) No Hired outomo6iles ( X ) Yes ( ) No D. Additional Insured Endorsement: The insured agrees that the City of Huntington Beach City Council„and/or aII,City,Council appointed groups;"committees ', COMM ISM arrs;'boards and any other City Council appointed body,and/or elective and,appointive officers;servants or{employees of '` . the Clty,of Huntington Beach;when acting as such are additional assureds hereunder. E. Hol.d Harmless-Agreement: The Insured agrees to6 protect, defend, indemnify and save harmless the CI y of;Huntington' Beach oaainst loss, damage or expense by-reason of any suits, claims, demands, judgements and causes"of,dc'ti'on cdused by insured,,hIS employees, agents or any subcontrai:tor arising out of or inconsequence of;.tlie "performanole of aII'or any opeiations covered by the certificate of Jnsurance,and such.insurance shall be primary to any Insurance;of...the..6it': F. Minimum Limits Required: --- — CombinB $in letimit Bodily Injury and/or Pro ert Dama a%includin Products La 9 Y Y P Y 9 9 abllaty '";$1 OOO,OOO cormbinecl'Single limit per occurrence, . G. Remarks:.'. .E & 0 1,1141 TS.. _l9 Z S fi w. ".+ "; Date FEBUARY 10, .1975 1. COMPANX REPRESENTATIVE. NametISURANCE COMPANY OF THE PACIlaC Insurance Company COAST SIGNATURE OF AUTHQRIZED`REPRESENTATNE Agent Address 620 NEWPORT CENTER DRIVE,' address" b20 NEWPORT CENTER DRIVE, NEWPORT BEACH CALIFORNIA .City NEWPORT BEACH. CALIFOR1tiTIA Telephone SLID+-8550 j APPROVED AS TO Fo WX P. BONFA Clty Attorne By: 1 � puty City ttc•rney WFA F'IREMA IIT'S r �'� :1v1AN'S FUND INSURANCE COMPANY . ElTIE AMERICAN INSURANCE COMPANY CERTIFICATE FUND ❑ NATIONAL SURETY CORPORATION OF INSURANCE 0 AMERICAN ❑ ASSOCIATED INDEMNITY CORPORATION ❑ AMERICAN AUTOMOBILE INSURANCE COMPANY APPROVED AS TO FORM'. INSURANCE COMPANIES ❑ DON P. BONFA City Attorney / 9 CITY OF HUNTINGTON BEACH BY= P.O. BOX 190 DATE Aycity HUNTINGTON BEACH , CA. 92648 1-28-75 L J THIS IS TO CERTIFY THAT THE COMPANY OR COMPANIES CHECKED ABOVE HAVE IN FORCE AS OF THE DATE HEREOF THE FOLLOWING POLICY OR POLICIES: NAME AND ADDRESS OF INSURED OR EMPLOYER LOCATION OF PROPERTY,DESCRIPTION OF OPERATIONS,BUSINESS CONDUCTED HUNTINGTON BEACH UNION HIGH SCHOOL DISTRICT 1902 17TH STREET HUNTINGTON BEACH, CA. KIND OF INSURANCE POLICY NUMBER EXPIRATION LIMITS OF LIABILITY WORKMEN'S COMPENSATION STATUTORY EMPLOYERS' LIABILITY THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH ACCIDENT BODILY INJURY LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS,EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE OPERATIONS THOUSAND DOLLARS,AGGREGATE PROTECTIVE THOUSAND DOLLARS,AGGREGATE CONTRACTUAL THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS AUTOMOBILE: BODILY INJURY LIABILITY* THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE PROPERTY DAMAGE LIABILITY* THOUSAND DOLLARS,EACH OCCURRENCE MEDICAL PAYMENTS $ EACH PERSON COMPREHENSIVE-LOSS OF OR DAMAGE TO THE ACTUAL CASH VALUE UNLESS OTHERWISE STATED HEREIN AUTOMOBILE, EXCEPT BY COLLISION OR UPSET BUT INCLUDING FIRE, THEFT AND WINDSTORM S ACTUAL CASH VALUE LESS COLLISION OR UPSET DEDUCTIBLE COMMERCIAL EXCESS THIS IS A EXCESS LIABILIT LIABILITY POLICY XLX 105 20 2i 11-8-75 POLICY PROVIDING THE DIFFERENCE BETWEEN PRIMAR LIMITS AND 1 ,000,000 COMB NED SINGLE LIMITS DESCRIPTION AND LOCATION OF OPERATIONS AND AUTOMOBILES COVERED IF THIS POLICY IS CANCELLED OR CHANGED IN SUCH A MANNER THAT WILL AFFECT THIS CERTIFICATE, THE INSURANCE COMPANY AGREES TO GIVE 30 DAYS PRIOR WRITTEN NOTICE , BY MAIL, TO CITY OF HUNTINGTON BEACH , P.O. BOX 190 HUNTINGTON BEACH , CA. 92648 *IF COMPREHENSIVE,SO STATE. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POLICY OR POLICIES SHOWN ABOVE. T REP ENTATIVE FNVENT OF ANY MATERIAL CHANGE IN OR CANCELLATION OF THE POLICY ORCIES THE COMPANY WILL MAKE EVERY EFFORT TO NOTIFY THE ADDRESSEE BUT ERTAKES NO RESPONSIBILITY BY REASON OF FAILURE TO DO SO. .TONES-GI LESP -GOPP R INS . lC 3 385054-1-71 ® FIREMAN'S eMAN'S A FUND INSURANCE COMP ' L I E AMERICAN INSURANCE COMPANY CERTIFICATE ' NY FUND ❑ NATIONAL SURETY CORPORATION OF INSURANCE AMERICAN El ASSOCIATED INDEMNITY CORPORATION El AMERICAN AUTOMOBILE INSURANCE COMPANY Y,� .- INSURANCE COMPANIES ❑ '^ -� vB;1V AS !M fo g ' DON F. BONFA TO: City Attorney CITY OF UUNTINGTON BEACH P.O. BOX 190 DATE BY: HUNTINGTON BEACH, CA. 92648 3-28-75 Deputy City Attarnej THIS IS TO CERTIFY THAT THE COMPANY OR COMPANIES CHECKED ABOVE HAVE IN FORCE AS OF.THE DATE HEREOF THE FOLLOWING POLICY OR POLICIES: -NAME AND ADDRESS OF INSURED OR EMPLOYER LOCATION OF PROPERTY,DESCRIPTION OF OPERATIONS,BUSINESS CONDUCTED HUNTINGTON REACH VVION BICH SCHOOL DISTRICT 1902 17TH STREET RU14TINCTON BEACH, CA. KIND OF INSURANCE POLICY NUMBER EXPIRATION LIMITS OF LIABILITY WORKMEN'S COMPENSATION STATUTORY EMPLOYERS' LIABILITY THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH ACCIDENT BODILY INJURY LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS, EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE OPERATIONS THOUSAND DOLLARS,AGGREGATE PROTECTIVE THOUSAND DOLLARS,AGGREGATE CONTRACTUAL THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS AUTOMOBILE: BODILY INJURY LIABILITY* THOUSAND DOLLARS, EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE PROPERTY DAMAGE LIABILITY* THOUSAND DOLLARS,EACH OCCURRENCE MEDICAL PAYMENTS $ EACH PERSON COMPREHENSIVE—LOSS OF OR DAMAGE TO THE ACTUAL CASH VALUE UNLESS OTHERWISE STATED HEREIN AUTOMOBILE. EXCEPT BY COLLISION OR UPSET BUT INCLUDING FIRE, THEFT AND WINDSTORM $ ACTUAL CASH VALUE LESS COLLISION OR UPSET $ DEDUCTIBLE C01MER- CIAL EXCESS THIS IS A EXCESS LIABILITY' LIABILITY POLICY XLR 105 20 ,26 I1-8-75 POLICY PHUVIDTWG THE DivrER.EHCE BETWEEN PRIMARY LI ITS AND 1,000,0€ 0 COMBINED SINGLE LIMITS DESCRIPTION AND LOCATION OF OPERATIONS AND AUTOMOBILES COVERED IF THIS POLICY IS CAIT'CELLED OR CUAHGED IN SUCH A KAliNER THAT ITILL AFFECT THIS CE'RTIFICATE, THE T�SURAWCE COMPANY AGREES TO GIVE 30 DAYS PRIOR WRITTEN NOTICE., BY 14AIL , TO CITY OF HUNTINGTON BEACH., P.O, BOX 190 UUnTIUCTON BEACH, CA. 92648 *IF COMPREHENSIVE,SO STATE. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR N ATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POLICY OR POLICIES SHOWN AB VE. TD R ENTATIVE IN EVENT OF ANY MATERIAL CHANGE IN OR CANCELLATION OF THE POLICY OR POLICIES THE COMPANY WILL MAKE EVERY EFFORT TO NOTIFY ADDRESSEE BUT UNDERTAKES NO RESPONSIBILITY BY REASON OF FAILURE DO SO. c) Esc i; 3 85054-1-71 AdWPAFA FIREMAIVS- -• L EMAN'S„FUND INSURANCE COMPANY IL�J E AMERICAN INSURANCE COMPANY CE�R7�TIMCATE FUNDElNATIONAL SURETY CORPORATION OF INSURANCE ® -AMERICAN ❑ ASSOCIATED INDEMNITY CORPORATION ❑ AMERICAN AUTOMOBILE INSURANCE COMPANY APPROVED AS TO FORM: INSURANCE COMPANIES ❑ DON P. BONFA TO: City Attorney F CITY OF H—UNTIRCTON BEACH By: P.O. Bax 190 DATE Deputy City Attorney HUNTINGTON BRACH, ��. 92��$ 1-*25-75 L J THIS IS TO CERTIFY THAT THE COMPANY OR COMPANIES CHECKED ABOVE HAVE IN FORCE AS OF THE DATE HEREOF THE FOLLOWING POLICY OR POLICIES: NAME AND ADDRESS OF INSURED OR EMPLOYER LOCATION OF PROPERTY,DESCRIPTION OFOPERATIONS,BUSINESS CONDUCTED HUNTINGTON DBACH UNION HIGH SCHOOL DTSTRrCT 1902 17TH STREET HUNTINGTON BPACH, CA, KIND OF INSURANCE POLICY NUMBER EXPIRATION LIMITS OF LIABILITY WORKMEN'S COMPENSATION STATUTORY EMPLOYERS' LIABILITY THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH ACCIDENT BODILY INJURY LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS,EACH OCCURRENCE .-, THOUSAND DOLLARS,AGGREGATE OPERATIONS THOUSAND DOLLARS,AGGREGATE PROTECTIVE THOUSAND DOLLARS,AGGREGATE CONTRACTUAL THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS AUTOMOBILE: BODILY INJURY LIABILITY* THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE PROPERTY DAMAGE LIABILITY* THOUSAND DOLLARS,EACH OCCURRENCE MEDICAL PAYMENTS $ EACH PERSON COMPREHENSIVE—LOSS OF OR DAMAGE TO THE ACTUAL CASH VALUE UNLESS OTHERWISE STATED HEREIN AUTOMOBILE, EXCEPT BY COLLISION OR UPSET ` BUT INCLUDING FIRE, THEFT AND WINDSTORM $ ACTUAL CASH VALUE LESS COLLISION OR UPSET $ DEDUCTIBLE COMMERCIAL EXCESS THIS IS A EXCESS LTABILITY LYABILITY POLICY- XLX 105 20 25 11- 8--75 POLICY -PROVIDING THE t3TFFEUBHCB DETWE.EB PRI AR LIMITS ABD 1,€00,000 COMB MED SINGLE LIMITS DESCRIPTION AND LOCATION OF OPERATIONS AND AUTOMOBILES COVERED IF THIS POLICY IS CAUCZ LED OR CHANGED TO SUCH A MANNER THAT WILL AVIEECT TITS CERTIFICATt THE 19SDEANCE COMPANY .AGREES TO GIVE 3=11 DAYS PRIOR VTRITTEN NOTICE, BY MAIL . TO CITY OF HUNTI GTO BE CH, P..O r SOX 1.90 HUNT%NGTON BEACH, CA. 92648 *IF COMPREHENSIVE,SO STATE. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POLICY OR POLICIES SHOWN ABOVE. U ED R SENTATIVE FNVENT OF ANY MATERIAL CHANGE IN OR CANCELLATION OF THE POLICY ORCIES THE COMPANY WILL MAKE EVERY EFFORT TO NOTIFY THE ADDRESSEE BUT eES—CLLE ( lz-Copp , ItTHS. !cj - ERTAKES NO RESPONSIBILITY BY REASON OF FAILURE TO DO SO. - *j •7 {,,p CAA j 3 85054-1-7 1 R -FIREM�IN'S`;' 11 � T EMA''S FUND INSURANCE COMPANY IS E AMERICAN INSURANCE COMPANY' ' CERTIFICATE FUND ❑ NATIONAL SURETY CORPORATION OF. INSURANCE AMERICAN ❑ ASSOCIATED INDEMNITY CORPORATION ❑ AMERICAN AUTOMOBILE INSURANCE COMPANY 'APPROVED AS .TO F'ORMs, INSURANCE COMPANIES ❑ DON P. BONFA TO: City Attorney CITY OF HUNTINGTON BEACH B P.O. BOX 190 y° HUNTINGTON BEACH , CA. 92648 DATE 1-28-75 Deputy City Attorney" L THIS IS TO CERTIFY THAT THE COMPANY OR COMPANIES CHECKED ABOVE HAVE IN FORCE AS OF THE DATE HEREOF THE FOLLOWING POLICY OR POLICIES: NAME AND ADDRESS OF INSURED OR EMPLOYER LOCATION OF PROPERTY,DESCRIPTION OF OPERATIONS,BUSINESS CONDUCTED HUNTINGT'ON BEACH UNION HIGH - SCHOOL DISTRICT 1902 17TH- STREET HUNTINGTON BEACH, CA. , KIND OF INSURANCE POLICY NUMBER EXPIRATION LIMITS OF LIABILITY WORKMEN'S COMPENSATION - STATUTORY EMPLOYERS' LIABILITY THOUSAND DOLLARS, EACH PERSON . THOUSAND DOLLARS, EACH ACCIDENT BODILY INJURY LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS,EACH PERSON THOUSAND DOLLARS,EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS ' PROPERTY DAMAGE LIABILITY OTHER THAN AUTOMOBILE* THOUSAND DOLLARS, EACH OCCURRENCE THOUSAND DOLLARS,AGGREGATE OPERATIONS I• THOUSAND DOLLARS,AGGREGATE PROTECTIVE THOUSAND DOLLARS,AGGREGATE CONTRACTUAL THOUSAND DOLLARS,AGGREGATE PRODUCTS AND COMPLETED OPERATIONS AUTOMOBILE_----- ----- --- BODILY INJURY LIABILITY* THOUSAND DOLLARS, EACH PERSON ' THOUSAND DOLLARS,EACH OCCURRENCE PROPERTY DAMAGE LIABILITY* THOUSAND DOLLARS,EACH OCCURRENCE MEDICAL PAYMENTS EACH PERSON COMPREHENSIVE-LOSS OF OR DAMAGE TO THE ACTUAL CASH VALUE UNLESS OTHERWISE STATED HEREIN AUTOMOBILE, EXCEPT BY COLLISION OR UPSET , BUT INCLUDING FIRE, THEFT AND WINDSTORM S ACTUAL CASH VALUE LESS COLLISION OR UPSET ¢ y DEDUCTIBLE - •i\ COMMERCIAL EXCESS THIS IS A EXCESS LIABILIT . LIABILITY POLICY XLX 105 20 2i 11-8-75 POLICY PROVIDING THE DIFFERENCE BETWEEN PRIMAR LIMITS AND 1 ,000,000 COMB NEI SINGLE .LIMITS DESCRIPTION AND LOCATION OF OPERATIONS AND AUTOMOBILES COVERED •IF -T'HIS POLICY IS CANCELLED CR CHANGED IN SUCH A MANNER THAT WILL ' h' AFFECT THIS '.CERTIFICATE , THE INSURANCE COMPANY AGREES TO GIVE . 30 DAYS PRIOR WRITTEN NOTICE , BY MAIL , TO CITY OF HUNTINGTON BEACH ,` P.O. ' BOX .190 . HUNTINGTON., BEACH , CA. 92648 *IF COMPREHENSIVE,SO STATE. , THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POLICY OR POLICIES SHOWN ABOVE. A H D REPR TATIVE IN EVENT OF ANY MATERIAL CHANGE IN OR CANCELLATION OF THE POLICY OR POLICIES THE COMPANY WILL MAKE EVERY EFFORT TO NOTIFY THE ADDRESSEE BUT i UNDERTAKES NO RESPONSIBILITY BY.REASON OF FAILURE TO DO 50. JONES—GILLESPIE-GOPPERT INS . /cj I ' 1 OFFICE OF 'I"' CITY ATTORNEY P. 0. BOX 190 ` HUNTINGTON BEACH F�arNtr CALIFORNIA 92648 DON P. BONFA TELEPHONE CITY ATTORNEY (714)5364M February 18, 1975 Mr. Paul Leddy Insurance Company of the Pacific Coast Post Office Box 2175 Newport Beach, California 92663 Dear Mr. Leddy : I am returning the enclosed certificate of insurance per our telephone conversation for reissuance with the proper liability limits . Very truly yours, DON P. BONFA City Attorney By �,G � AMES GEORGE �eputy City Attorney JG :k Enclosures L VVLr imou mimtoc VKVur DATE SUBJ r- ❑ GULF t 0- - '7 C&J- ❑ ATLANTIC ❑ SELECT ❑ I.P.C. TO FROM ADOR ES5 ANY REPLY TO: PLEASE TAKE ACTION BY COPY TO: FOLD THE FOLLOWING SPACE FOR SENDER'S MESSAGE I, { SIGNED, THE FOLLOWING SPACE FOR RECIPIENTS REPLY SIGNED, DATE FORM 970 (10-72) 3 PART SET COPY TO BE RETURNED