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Certificate of Insurance <br /> Sparta Program <br /> Name Insured: Public Entity: <br /> Adlerhorst International,Inc. SPARTA-SANTA ANA <br /> 20 Civic Center Plaza Po Box 1988 M-28 20 Civic Center Plaza Po Box 1988 <br /> Santa Ana,CA 92701 Santa Ana,CA 92701 <br /> Certificate Tenn 9/12/2001 Certificate# SSA00-0006 <br /> Coverage SPARTA INSURANCE PROGRAM:Commercial General Liability-Hazard 1 <br /> Contract Value: $16,000.00 <br /> Coverage Period: 9/12/2001 to 9/12/2002 <br /> Insurance Carrier: Essex Insurance Company <br /> Master Policy: 3CD558'1A <br /> Master Policy Effective Date:11/15/2000 to expiration <br /> Limits $2,000,000 General Aggregate/$1,000,000 Each occurrence/$1,000,000 Products/Completed operations/$1,000,000 <br /> Personal&Advertising Injury/$50,000 Fire Damage/Medical Payments Excluded <br /> Deductibles $500 RI&PD Per Claimant Including Loss Adjustment Expense <br /> $750.00 Premium(Fully Earned) <br /> $25.13 Taxes(Fully Earned) <br /> $50.00 Certificate Fee(Fully Earned) <br /> $825.13 Total Ana <br /> Terms& 1. No Cancellations Allowed <br /> Conditions 2, Operations and Rating Based:Training K-9&police officers on city property. (No public exposure). <br /> 3. Contractual on a Limited Form, NO PROFESSIONAL LIABILITY COVERAGE PROVIDED. <br /> 4.Additional hisured(s):N/A <br /> 5.Department: Santa Ana Police Department <br /> Exclusions Per the Master policy,a copy is available by written request to:Municipality Insurance Services,Inc. 1920 East 17th St <br /> Suite 130, Santa Ana,CA 92705 <br /> The Insurance afforded under the specified policy above is subject to all the terms, conditions, and exclusions of such <br /> policy. (A copy of the policy is available upon written request.) This coverage applies only to the contractor or event <br /> noted above and does not extend to any other activities or work performed by the holder. —/ <br /> �.L �4✓/ Q—D 0/ <br /> Carol Frost/President Date <br /> Municipality Insurance Services, Inc. <br /> #(314157@� 1920 East 17th St Suite 130 <br /> 4)�N12 Santa Ana,CA 92705 <br /> it <br /> to <br /> A. ;aO v ED AS TO FORM. <br /> • <br /> c% \sco£6Z 82t'y <br /> a a Sheedy <br /> Deputy City Attorney <br /> 1920 East 17th St Suite 130 Santa Ana,CA 92705(800)420-0555 (714)550-5040 fax(714)550-5044 License#0004849 <br />