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ACORD CERTIFICATE OF LIABILITY INSURANCE <br />012/33 /zoos' <br />PRODUCER (909) 587 -2719 FAX (909) 587 -6001 <br />Anthem Insurance <br />42145 L ndie Ln. , #202 <br />Y <br />Temecula, CA 92591 <br />License # OB84551 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED Boys and Girls Club of Santa Ana <br />950 Highland St <br />Santa Ana, CA 92703 <br />INSURER Markel Insurance Company <br />POLICY EFFECTIVE <br />INSURER B'. <br />LIMITS <br />INSURER C. <br />INSURER D'. <br />8502CY073003 <br />INSURER E. <br />01/05/2005 <br />&rr.q <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI <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 />INSR <br />DD' <br />fjS. <br />­TYPE INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY E %PIRATION <br />QDjYYj <br />LIMITS <br />GENERAL LIABILITY <br />8502CY073003 <br />12/20/2003 <br />01/05/2005 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />$ 50,000 <br />CLAIMS MApE ❑ OCCUR <br />VIED EXP (Any one person) <br />$ 5,000 <br />PERSONAL B ADV INJURY <br />$ 1,000,000 <br />A <br />X <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMPIOP AGO <br />$ 1,000,000 <br />POLICY je CT LOC <br />AUTOMOBILE <br />LIABILITY <br />1002CYCO730044 <br />12/20/2003 <br />01/05/2005 <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />(Ea accident) <br />$ <br />1,000,000 <br />BODILY INJURY <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />A <br />X <br />BODILY INJURY <br />$ <br />HIRED AUTOS <br />NON OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE <br />$ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />$ <br />ANY AUTO <br />$ <br />AUTO ONLY'. AEG <br />EXCESSIUMBRELLA LIABILITY <br />4602CY0730105 <br />12/20/2003 <br />01/05/2005 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />$ 5,000,000 <br />A <br />X <br />$ <br />$ <br />DEDUCTIBLE <br />X RETENTION $ 10,00 <br />$ <br />WORKERS COMPENSATION AND <br />WC STATU- OTH- <br />PR <br />EMPLOYERS' LIABILITY <br />ANV PROPRIETORIPARTNERiEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />E. L. EACH ACCIDENT <br />$ <br />EL.DISEASE - EAEMPLOYEE <br />$ <br />If PBe, describe under <br />SPECIAL PROVISIONS below <br />l <br />E . DISEASE - POLICY LIMIT <br />$ <br />OTH <br />10 Way cancel non <br />payment of premium <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />E: City of Santa Ana, its officer, agents and employees are named as additional insured <br />as respects the operations of the named insured. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL K"XJOk7fi16 MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />City of Santa Ana <br />20 Civic Center Plaza KS(d47FXi <br />Santa Ana, CA 92701 AUTHORIZED <br />AUL)KL) ZO (ZUU1/Ut3) ©ACORD CORPORATION 1998888 <br />1 " V <br />