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ACORO • CERTIFICATE <br />Fitness & wellness Insurance <br />Agency <br />380 Stevens Ave., First Floor <br />Solana Beach CA 92075 <br />Phone:800-395-8075 Fax:858-519-0822 <br />Choc V.Le #0375057 <br />8ff: 01-06-03 <br />4 Fabriano <br />Irvine CA 92620 <br />LIABILITY INSURANC <br />ALTER THE COVERAGE <br />INSURERS AFFORDING COVERAGE <br />INSURER B: <br />INSURER C: <br />OPID R oATEIMMIDDIYYYY) <br />0375057 03/28/03 <br />A MATTER OF INFORMATION <br />UPON THE CERTIFICATE <br />S NOT AMEND, EXTEND OR <br />:D BY THE POLICIES BELOW. <br />NAIC # <br />nal Insuranc <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 />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MMIO <br />DATE (MWDDfyyl <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />f1,000,000 <br />TAN -ro-FA <br />PREMISES Faaccurence) <br />$100,000 <br />X <br />X COMMERCIAL GENERAL LIABILITY <br />3XZ126451-02 <br />01/06/03 <br />01/06/04 <br />CLAIMS MADE D OCCUR <br />MED EXP (Anyone Person) <br />S 2 , 500 <br />PERSONAL SADVINJURY <br />$1,000,000 <br />A <br />X Misc.Professional <br />GENERAL AGGREGATE <br />$3, 000, 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS -COMPIOP AGG <br />$1,000,000 <br />POLICY 7 PRO-JECT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />COMBINED SINGLE LIMB <br />(Ea accident) <br />$ <br />BODILY INJURY <br />(Per Person) <br />f <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per accident) <br />S <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Peraccident) <br />f <br />GARAGE LIABILITY <br />AUTO ONLY • EA ACCIDENT <br />S <br />OTHER THAN EA ACC <br />$ <br />ANY AUTO <br />S <br />AUTO ONLY: AGG <br />EXCESS/UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />$ <br />f <br />$ <br />DEDUCTIBLE <br />f <br />RETENTION $ <br />WORKERS COMPlNSATIGN AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTNE <br />OFFICER/MEMBER EXCLUDED? <br />TORV LIMBS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE- EA EMPLOYE <br />S <br />If s, describe under <br />SPECIAL PROVISIONS belay <br />E.L. DISEASE • POLICY LIMB <br />S <br />OTHER <br />A <br />Sexual Abuse <br />3XZ126451-02 <br />100,000 <br />300,000 <br />)ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS APPROVED FORM <br />AS TO <br />It is understood and agreed City of Santa Ana, its officersagents, V 1�lYl <br />employees, representatives, and volunteers are added as addition <br />insuered per the attached form CG201011/85 <br />La) U Dicedy <br />I)g1titY City Attorney <br />CERTIFICATE HOLDER CANCELLATION <br />SANANAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, 30 DAYS WRITTEN <br />City of Santa Ana Parka and NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Recreation, & Community <br />Services Agency <br />P.o. Box 1988 M-23 <br />Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE <br />