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<br />Page I of I <br /> <br />Certificate of Insurance <br />Sparta Program <br /> <br />A - cJ,oo3 - / frO <br /> <br />Named Additional Insured: <br /> <br />SANTA ANA (SPARTA) Bordereau <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br /> <br />Name Insured: <br /> <br />Adlerhorst International, Inc. <br />3951 Vernon Ave <br />Riverside, CA 92509 <br /> <br />Certificate # <br />Coverage <br /> <br />Limits <br /> <br />Deductibles <br /> <br />Terms & <br />Conditions <br /> <br />Exclusions <br /> <br />SSA03-0019 <br /> <br />SPARTA INSURANCE PROGRAM: Commercial General Liability - Hazard I <br />Contract Value: $16,000.00 <br />Coverage Period: 2/l/2004 to 2/1/2005 <br />Insurance Carrier: Essex Insurance Company <br />Master Policy: 3CM4080 <br />Master Policy Effective Date: 11/1 5/2003 to expiration <br /> <br />$2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Completed operations / <br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage / Medical Payments Excluded <br /> <br />$500 BI & PD Per Claimant Including Loss Adjustment Expense <br /> <br />$750.00 Premium (Fully Earned) <br />$23.44 Taxes (Fully Earned) <br />$50.00 Certificate Fee (Fully Earned) <br />TRIA <br /> <br />$823.44 <br /> <br />Total Amount <br /> <br />I. No Cancellations Allowed. Premium, taxes and fees are fully earned at inception. <br />2. Operations and Rating Based: Training K-9 & police of ricers on city property. (No Public Exposure). <br />3. Department: Santa Ana Police Department <br />4. Additionallnsured(s): Not Applicable <br />5. NO PROFESSIONAL LIABILITY COVERAGE PROVIDED. <br />6. NO PUBLIC EXPOSURE WORKING WITHIN THE CITY OF SANTA ANA DEPARTMENTS AND THEIR <br />EMPLOYEES ONLY. <br />7. NO COVERAGE PROVIDED FOR ANIMAL MORTALITY ORDOG BITES. <br /> <br />Asbestos, Assault & Battery, Employer Related Practices, Subsidence, Independent Contractors, Pollution, Cross <br />Suit, Lead or Silica Dust, Mold or Bio-organic Growth 0' Mildew, Punitive Damages, Animal, Breach of Contract, <br />Y2K Electronic Data, Medical Payments, War or Terro,¡sm. <br />The insurance provided under this policy is limited to your work performed on behalf of the entity named as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or your <br />organization. Coverage is limited to the description of operations and rating bases listed in "Terms & Conditions" <br />item 2. <br /> <br />The Terrorism Risk Insurance Act of2002, requires us to offer you a quote for terrorism coverage. This Quotation is <br />separate and not included in your coverage premium. This coverage must be accepted or rejected by you and the <br />attached form returned to us prior to binding. <br /> <br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, Inc. 1920 East 17th <br />St Suite 136, Santa Ana, CA 92705 <br /> <br />~ <br /> <br />~~ <br /> <br />Carol Frost / President <br />Municipality Insurance Services, Inc. <br /> <br />1920 East 17th St Suite 136 Santa Ana, CA 92705 (800) 420-0555 (714) 550-5040 fax (714) 550-5044 License# OC04849 p'IP'}- <br />