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ACORD • CERTIFICATE W LIABILITY INSURANCEW OPID R MI OATE(MDDMYYY) <br />0375057 03 28 03 <br />PRODUCE a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Fitness & Wellness Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />380 Stevens Ave., First Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Solana Beach CA 92075 <br />Phone:800-395-8075 Fax:858-519-0822 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Specialty National Insuranc <br />INSURER B: <br />Choc V. Le #0375057 Eff: 01-06-03 INSURER C: At - Z OVvz <br />4 Fabriano INSURER D: <br />Irvine CA 92620 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <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 />TR <br />ROW' <br />INSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MMIO <br />POLICY EXPIRATION <br />DATE (MM/DD1YY1 <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />S1,000,000 <br />A <br />X <br />X COMMERCIAL GENERAL ABILITY <br />CLAIMS MADE [ X] OCCUR <br />3XZ126451-02 <br />01/06/03 <br />01/06/04 <br />RTED <br />PREMISES(Ea trance) <br />f100,DUD <br />MED EXP (Any one person) <br />$2 , 5 0 0 <br />A <br />X Nisc.Professional <br />PERSONAL dADVINJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$3,000,000 <br />GEML AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG <br />S1,000,000 <br />POLICY JECT LOC <br />AUTOMOBILE <br />UASILI7Y <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per person) <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />BODILY accide t) <br />(Par accident) <br />S <br />PROPERTY DAMAGE <br />(Per accident) <br />S <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />S <br />ANY AUTO <br />OTHER EA ACC <br />S <br />$ <br />AUTO ONLY: AGO <br />EXCESSIUMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />S <br />DEDUCTIBLE <br />S <br />RETENTION $ <br />S <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />TORYLIMITS I ER <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />IT s. descdba under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - EA EMPLOYE <br />S <br />E.L. DISEASE -POLICY LIMIT <br />E <br />OTHER <br />A <br />Sexual Abuse <br />3XZ126451-02 <br />100,000 <br />300,000 <br />IESCRtPT10Nn OPERATIONS/LOCATIONS/VEHICLES CityEXCLUSIONSof ADDEDBYENDORSEMENT/SPECIAL PROVISIONS APPROVED AS TO FORM <br />It is understood and agreed City of Santa Ana, its officers, agents, 1VY1 <br />employees, representatives, and volunteers are added as addition <br />insuered per the attached form CG201011/85 <br />La N Reedy <br />0riity City Attorney <br />-=K I IrII.A 1 C KULMCK <br />City of Santa Ana Parks and <br />Recreation, & Community <br />Services Agency <br />P.O. Box 1988 N-23 <br />Santa Ana CA 92702 <br />SANANAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATII <br />DATE THEREOF, 30 DAYSWRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, - <br />