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<br />J <br /> <br />12-13-'04 12:38 FROM-ALL-CAL INSURANCE <br /> <br />9167840158 <br /> <br />T-358 P002/007 F-682 <br /> <br />i!CORD~ CERTIFICATE OF LIABILITY INSURANCE 1 DATI;: (MMlDDNYYY) <br /> 12/13/2004 <br />PRoDUceR (916) 784-9070 fr- 2ab-1A-\. THIS C~RTlFICAT~ IS ISSU~D AS A MATTER OF Ii'4FORMATION <br /> ONLY AND CONF~RS NO RIGHTS UPON THE CERTIFICATE <br />All-Cal Insurance Agency HOLD~R. THIS C~RTIFICA T~ DO~S NOT AMEND, EXTEi'40 OR <br />BOl River$~de Avenue #105 Pr -~ -14 (j AL T~R TH~ COV~RAG~ AFFORD~D BY TH~ POLICIES BELOW. <br />Attn: Beve~ly <br />RosQvil1e CA 95678- INSURERS AFFORDIi'4G COVERAG~ , i'4AIC# <br />INSURED IN......R I< NON PROFI~S INS ALLIANCE A VI <br />Ca1ifornia H~spanic Commission on Alcohol INsu.E.",NOR~H AMERICAN ELITE lNS. <br />and Drug Abuse Prevent~on INSURER C: , , <br />2101 Capitol Avenue INSURER 0: <br />Sacramento CA 95816- INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN~ <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wln-l RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR '~'i:~ POl.leV NUMIilIiR ~'-+'i";Jt&~ POLICY IiXPIRAnON LlMlT$ <br />LT. INS TV,.e O~ INSURANOli DATEfMMI~ <br />A X ~Ne.RAl. LIABILITY / / / / EACH OCCuRRENCE . l,OOO,OC <br /> DAMA:i,E JD RENTEO <br /> ~ ~r"EflClAL OeNl:RA1..llASlulY PREMI E l tEa OOCUmln08' . 50/0C <br /> - CLAIMS MACE ~ OCCUR. 2004-03026 n/18/2004 11/18/2005 MEO EXp fMv 011& DBrloon} . s,oe <br /> X PROFESSIONAL LIAB. PERSONAL &M>V INJURV . 1,OOO/OC <br /> X ~OYEE aEN1Fl~S / / / / GE:NERAL AGGReGAtE . 2/000jOC <br /> -;Z;~ AGG~nE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $, 2,OOO,OC <br /> X POl.ICY ~~ - n l.oe / / / / IMPROPER SEXUAL COHO 1,OOO/OC <br />A X ~TOMOBIl.E LIABILITY / / / / COMB1NED SINGLE UMIT 1/00010C <br /> (Ea iU:x:id'ant) . <br /> - ANY AUTO <br /> - ALL QIMolEO AUTOS 2004-0302t5 n/1B/2004 n/18/2005 8001L Y INJURY <br /> (Par person) . <br /> .!- SCHEDUl.ED AUTOS <br /> .!- HIRED AUTOS ,d / / / BODILY INJURY <br /> . <br /> .!- NON-Q\l\NEDAIJTOS ,\:U " (P<< acddtir"ll) <br /> X C(!Id:lI' D2D: $250 !,>-'P {V' / / PROPERTY DAMAGE <br /> X $500 _.....t\> ,H l' (Pet'~dlM\l) $ <br /> COLLISION 0110: <br /> ~~GO LIABILITY ,<:~~~ (,'f-. e~ AUTO ONLY -EAACCIOENT . <br /> ANY AUTO V. '( S,O \\0\1' / / / . <br /> ~p" \Sl'- S'C;\\~ OTf..Il:R THAN ""ACC . <br /> AUTOONl.Y: AGG $ <br />A X ~E5SlUM8RElL.A UA,8IUTY ./ ,,/,,'(0' P / / / / EACH OCCuRRENCe . 4/000/0C <br /> X OCCUR. 0 CkAlMS MADE 1'-'0 G}OOO/OC <br /> /) AOl3F1EGATE $ <br /> " <br /> . <br /> ;:l ~EDUCTIBLE 2004-03026UMB \ 11/18/2004 11/1B/2005 $ <br /> X RETENTION $10,000 . <br /> WORKIiRS COMPENSATION AND / / / / I~L'llHsl 1'1!,\' <br /> EMPLOYIiRS' UABlLlTY <br /> ~y F'ROPRIElORlf'AA'(Nf:M:XeCuiIVE E.l. EACH ACCIDENT . <br /> OFFICERlMEMBER EXClUDED? / / / / EL. DISEASE - EA eMPL,OY~E $ <br /> ltY8&,<!escribeunder <br /> SPECIAL PROVISIONS ~Iow E:.L. DISeASe:. POUCYUMJT $ <br />Il OTHO. l'INt'LOnl'l DISHONES'rY CWB 000 2271 02 03026 11/18/2004 11/18/2005 LIMI' $100,OC <br /> FORGERY/ALTERATION OWB 000 2271 O' 03026 11/18/2004 11/18/2005 OEDUCTION $5C <br />A DIRECTORS & OFFICERS 2004-03026Do 11/18/200' 11/1B/2005 LIMI' $ 1,000/00 <br />DESGRJP110NOF OPERATJONSlLOGA1l0NSlViHlGLESJEXGLUSlONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br />THE CITY OF SANTA ANA, ITS on-leERS, AGmNTS, OFFICIAt.S, EMPLOYEES, .MID 'V'O!.UNl'EERS AltE NAMED AS ADDITIONAL :rNSURlilD AS <br />FUNDIN'G SOURCE TO 'I!HE INStmED _ FORM CG 2026 APPLIES_ <br /> <br />ANABELL !lA~ES <br /> <br />CANC~LLA 1101'4 <br />SHOULD ANY OF THE ABOYa DEBCRlElIiC POI.lOliS BE CANOIeI.I.E!c sEFOm: THE <br />EXPIRA110N DATE THEREOF. THI! ISSUING INSURER WILL ~ MAIL <br />~ DAYS WRITTeN NOTICE TO THE CERTIFICATE HOLOER NAMIt:O TO THIi I.EFT, tfOO <br />~_I!I_lfl(lOOIlOOiC~ltII, <br />~ ~llI/Ilill~_KOlll: <br />AlI'l'HO ED REPftU "lIVE <br /> <br /> <br />..ACORD CORPORATION'9 <br />Psg.. 1 ' <br /> <br />CERTIFICATE HOLD~R <br />( ) <br /> <br />CITY OF SAN~A ANA <br />P,O. BOX 1988 M-73 <br />20 CIVIC CEN~ER PLAZA <br />SAN~A ANA CA <br />. ACORO 25 (2001/08) <br />ftr~-li'4S025 (0108).05 <br /> <br />92701 <br /> <br />ELECTRONIC lASER fORMS. I <br /> <br />