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AUf; 06 04 02:32p Jerr~ Verdì 415-705-6533 p. 1 CERTIFICATE OF INSURANCE This certifies that o STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois 181 STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois o STATE FARM FIRE AND CASUALTY COMPANY, Scarborough. Ontario o STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida o STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages indicated below: Name of policyholder DANIEL BAY Address of policyholder 65 VALLEJO WAY, SAN RAFAEL, CA 94903 Location of operations SAME Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period) 97-QY-8259-1 Comprehensive 10/19/03 , 10/19/04 BODILY INJURY AND Business Liability : PROPERTY DAMAGE .---------------------------- -Cr prodü-ètŠ- :-ëömpleiåd"Òpërãtiöñš - -- - - -- ---- - -- - - - ---- - - -- -- This insurance includes: o Contractual liability o Underground Hazard Coverage Each Occurrence $ 1000000 o Personal Injury o Advertising Injury General Aggregate $ 2000000 o Explosion Hazard Coverage o Collapse Hazard Coverage Products - Completed $ 0 Operations Aggregate 0 POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date : Expiration Date (Combined Single Limit) o Umbrella Each Occurrence $ o Other Aggregate $ , Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation , , and Employers Liability Each Accident $ , Disease Each Employee $ , Disease· Policy Limit $ POLICY PERIOD UMITS OF UABILlTY POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period) : , , THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 3 0 days before Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed on State ADDITIONAL INSURED: Farm or i gents or re esentatives. THE CITY OF REDWOOD CITY, ITS OFFICIALS, EMPLOYEES, AND . VOLUNTEERS 1017 MIDDLEFIELD ROAD Signature of Au REDWOOD CITY, CA 94063 AGENT 8/6/04 Title Date RE: ORGANIZATIONAL DEVELOPMENT PROJECT AND FIRE DEPARTMENT I Agent's Code Stamp VERDI INSURANCE AGENCY 8 Califomia Street, Suite 200 San Francisco. CA 94111 558-994 a.3 04-1999 Printed In U.S.A. (415) 705-6530 Fax (415) 705-6533 Uc. 0493338 1 T T' .