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M CERTIFICATE OF LIABILITY INSURANCE iii3iizooal <br />PRODUCER (g09) 587-2719 FAX (909) 587-6001 <br />Anthem Insurance <br />42145 L ndie Ln. , #202 <br />Y THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Temecula, CA 92591 <br />License # OBS4551 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED goys and Girls Club of Santa Ana wsuRERA. Markel Insurance Company <br />9S0 Highland St INSURERe. <br />Santa Ana, CA 92703 wsuRER G. <br /> INSURER D: <br /> INSURER E'. <br />COVERAGE <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR OD' TYPE OFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY 8502CY073003 12/20/2003 01/05/2003 EACH OCCURRENCE $ 1,000,000 <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ SO,000 <br /> CLAIMS MADE ^ OCCUR MED EXP (Any one person) $ 5 ,DDD <br />A X PERSONALSADVINJURY $ 1, ODD,OO <br /> GENERAL AGGREGATE $ 3 ,DDD, DDD <br /> GEML AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OP AGG $ 1, DDD, DD <br /> POLICY PRO- <br />JECT LOC <br /> AUT OMOBILE LIABILITY 1002CYC0730044 12/20/2003 O1/OS/2005 COMBINED SINGLE LIMIT <br /> ANV AUTO IEa accitl¢np $ 1,DDD,DDD <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />A <br />X <br />SCHEDULED AUTOS <br />(Per person) $ <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OWNED AUTOS (Par aGtibenl) <br /> PROPERTY DAMAGE <br /> <br />(Par aLCitlanQ $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACG $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLALIABILITY 4602CY0730105 12/20/2003 01/03/2005 EACHGCCURRENCE $ 5,000,000 <br /> OCCUR ^CLAIMS MADE AGGREGATE $ S, QQD, D00 <br />A X $ <br /> DEDUCTIBLE $ <br /> X RETENTION $ 10,00 $ <br /> WORKERS COMPENSATION AND ~ ~ - ~ WC STATU- OTH- <br /> EMPLOVERS' LIPBILITY <br />~ ER_ <br /> ANV PROPR:F-TOR/; ARTNERiEiIECJTIVE . <br />r'l <br />~ EL EACH ACCIDENT $ <br /> OFFICER/MEMBER EXO WDEDP \ <br />-~. <br />~~~~ <br />~~- <br />//~ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br /> f y¢S, d¢5CfIbB UOtl¢r ri <br /> SPECIAL PROVISIONS below L:. E. L. DISEASE-POLICY LIMIT $ <br /> OTHE <br /> 10 c~ay cancel non <br /> payment of premium <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I E%CLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />E: City of Santa Ana, its officer, agents and employees are named as additional insured <br />s respects the operations of the named insured. <br />SHOULD ANY OF THE AROVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 14X>~XJOI2Xt6 MAIL <br />3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />City of Santa Ana wmr~lcl <br />20 Civic Center Plaza d(9(ASaFXi <br />Santa Ana, CA 92701 AUTHORIZED <br />AGORD 25 (2001/08) ©ACORD CORPORATION 1988 <br />f)~j/ <br />