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DATE (M MIDDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 12/31/2003 <br />PRODUCER (909) 587-2719 FAX (909) 587-6001 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Anthem Tnsurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />42145 Lyndie Ln., #202 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Temecula, CA 92591 <br />License # OB84551 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Boys and Girls Club of Santa Aha ~NSURERA Markel Tnsurance Company <br />950 Highland St INSURER B <br />Santa Ana, CA 92703 INSURERC: <br /> INSURER D <br /> INSURER E <br /> <br />COVERAGES <br /> <br /> THE POLICIES Of INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE iNSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN~ <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 /> JNSR ~NDD'L POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR SRE TYPE OF INSURANCE POLICY NUMBER DATE tMMIDDIYYI DATE IMMIDD/YY~ LIMITS <br /> I GENERALLIABILITY 8502CY073003 12/20/2003 01/05/2005 EACH OCCURRENCE $ 1,000,000 <br /> COMMERCIAL GENERAL LIAB[UTY DAMAGE TO RENTED $ 50 ~ 000 <br /> I <br /> CLAIMS <br /> MADE <br /> U OCCUR MED EXP (Any one person)$ 5,000 <br /> A X __ PERSONAL & ADV~NJURY $ 1,000,000 <br /> -- GENERAL AGGREGATE $ 3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/DP AGG $ 1 t 000,0001 <br /> AUTOMOBILE LIABILITY 1002CYC0730044 12/20/2003 O1/05/2005 COMBINED SINGLE LIMIT <br /> ANY AUTO (La acc/riehl) $ <br /> 1,000,00( <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) <br /> A X <br /> BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY . EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY 4602CY0730105 12/20/2003 01/05/2005 EACH OCCURRENCE $ 5 , 000,00( <br /> ~ OCCUR [] CLAIMS MADE AGGREGATE $ 5,000100( <br /> A X <br /> X DEDUCTIBLE $ <br /> RETENTION $ 10,000 i~,,~, ! ~,' <br /> WORKERS COMPENSATION AND I TORY LIMITR J <br /> <br /> SPECIAL PROVISIONS below I ! / , EL D~SEASE. POLICY L~M~T $ <br /> ~":°l~d"~'ay cancel non '' ;' <br /> ~ayment of premium <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES I EXCLUSIONS ADDED aY ENDORSEMENT I SPECIAL PROVISIONS <br />{E: City of Santa Ana, its officer, agents and employees are named as additional insured <br />is respects the operations of the named insured. <br /> <br />CERTIFICATE HOLDER <br /> <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br /> <br />ACORD 25 (2001/08) <br /> <br />CANCELLATIqN <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICieS BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER Will ~X~(~ MAIL <br /> 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> <br />©ACORD CORPORATION 1988 <br /> <br /> <br />