Laserfiche WebLink
CORD - CERTIFICATE LIABILITY INSURANC OP ID R DATE (MM OD/03 <br />0375057 03 28 03 <br />PR <br />DUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Fi <br />neSS & Wellness Insurance <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Ag <br />38 <br />ncy <br />Stevens Ave., First Floor <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />So <br />ana Beach CA 92075 <br />Pk. <br />one:800-395-8075 Fax:858-519-0822 <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSL <br />RED <br />INSURERA: Specialty National InsuranC <br />INSURER B: <br />Choc V. Le #0375057 <br />Eff: 01-06-03 - <br />INSURER C: _ OZ <br />INSURER D: <br />4 F riano <br />Irvine CA 92620 <br />INSURER E: <br />CO <br />ERAGES <br />TI <br />iE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />V REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />M <br />V PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MMID <br />DATE MWD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$1,000,000 <br />PREMISES(Eaccarence) <br />$100,000 <br />A <br />X <br />X COMMERCIAL GENERAL [ABILITY <br />3XZ126451-02 <br />01/06/03 <br />01/06/04 <br />CLAIMS MADE FX] OCCUR <br />MED EXP (Any one Pe mn) <br />$2 , 50 0 <br />PERSONAL SADVINJURY <br />$1,000,000 <br />A <br />X Misc.Professional <br />GENERAL AGGREGATE <br />$3,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS -COMP/OPAGG <br />S1,000,000 <br />POLICY PRO- LOC <br />JECT <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY <br />(Per Person) <br />S <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Par accident) <br />S <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <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 />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />S <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />$ <br />S <br />$ <br />DEDUCTIBLE <br />S <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />EMPLOYERS LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTNE <br />TORYLIMRS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />S <br />OFFICER/MEMBER EXCLUDED? <br />M yes. describeunder <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />S <br />OTHER <br />A <br />Sexual Abuse <br />3XZ126451-02 <br />100,000 <br />300,000 <br />]ES <br />It <br />RIPTION OF OPERATIONS T LOCATIONS T VEHICLES T EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS APPROVED AS 1O FORM <br />is understood and agreed City of Santa Ana, its officers, agents, <br />employees, <br />representatives, and volunteers are added as additions, <br />in <br />uered per the attached form CG201011/85 <br />Ladfn glicedy <br />P) rwy City Attorney <br />'E <br />TIFICATE HOLDER CANCELLATION <br />sBNANAc <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, 30 DAYS WRITTEN <br />City of Santa Ana Parks and <br />Recreation, & Community <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Services Agency <br />P.O. Box 1988 M-23 <br />01� <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 <br />Jeffrey E. Frick <br />25 (2001/08) 0ACORD CORPORATION 1988 <br />