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Celticate of Insurances <br />Sparta Program <br />l N»me Insured: <br />Omdorff, Jon <br />112 Second Street, Apt. 92 <br />Seal Beach, CA 90740 <br />Certificate # SSA03-0018 <br />Named Additional Insured: <br />SANTA ANA (SPARTA) Bordereau <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br />Carol Frost / President <br />Municipality Insurance Services, Inc. <br />A PAZ.OVED A k' T FORM <br />7 <br />Mic i8liotta <br />Deputy Citv Attorney <br />'? OFa <br />1920 East 17th St Suite 136 Santa Ana, CA 92705 (800) 420-0555 (714) 550-5040 fax (714) 550-5044 License# 0004849 <br />