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<br />JUN-23-2004 ~ED 10:45 AM K&K Insurance <br /> <br />FAX NO. 2604595821 <br />LAS <br /> <br />P. 02/02 <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />1033425 <br /> <br />ISSU~ DA'I't! (~YJ <br />6/23/04. <br /> <br />PRODUCER <br /> <br />K & ~ l~s~r~nce Gro~w, Inc. <br />~7l2 Magnavox Way <br />P,O. Box 2338 <br />~o:c W~yne. In 46aOl <br /> <br />THIS C!/tTlF'iCATE IS ISSUED AS A MATTER Of INFO~MATlON OIllL Y <br />AND CONFERS NO RIGHTS UPoN T'~~ CERTIFICATE HOLDER. THIS <br />ce~T'FICAT£. DOES Nor AMEND. E)(.TEND OR ALTER THE <br />COVERAGE AFFOROED BY TI-IE POLICIES BELOW. <br /> <br />COMPANIES AFFORDING COVERAGE <br /> <br />INSURED <br /> <br />)./-,»t.7~- éJ 4~ <br /> <br />COMPANY A <br />LETTER <br />COMPANY B <br />LEITER <br />COMPANY C <br />LETTER <br /> <br />VIRG!NIA SURETY COMPÄNY, !NC. <br /> <br />GLACIAL GARDEN I'NC. <br />D/B/A GI.ACIAL GARDEN ICE ~.R:eNJ>. (SEE GA.I <br />lQOO B. CERR:C'tOS AV.ENOB <br />AN~1EIM, CÄ 92BO~ <br /> <br />COVERAGES <br /> <br />THIS 15 TO CERTIFY THAT THE POLICIES OF IN&UF;:ANCe LI~>TE.D BELOW HAVE BEEN ISSuED TO T~E INSUREP NAMED ABOVE FOR THE POLICY <br />PERIOD INDICATE.D, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF AN"r' CONTRACT OR oniE~ DOCUMENT WITH RE!6F'ECT TO <br />WHICH THIS CERTIFICATa: IIIA"r' BE ISSUED OR MAY PERTAlIII. THE INSURANCE AFI"ORDED BY THE POLICIEs DESCRIBED HEREIN IS SUBJECT TO <br />AL~ THE TERMS, e)(CLUSIONS AND CONDITIONS OF SUCH f'OLIClfS LIMITS St10WN MAY HAVE BEEN REDUCED BY PAID C~IMS, <br /> <br />CO. <br />LTR <br /> <br />TYPE OF INSURANCE <br /> <br />POLlC.,. NuMElEFI <br /> <br />POLICY 6FFECTlVE POliCY EJØ'IAATIOf\I <br />ATf (MMIDCIYY) DATE ~ <br /> <br />LIMITS (In thousand..> <br /> <br />Genet' .Ili. bUlty <br />A. Ii] ComrnerclIll General Llilblllry <br />0 Claims Made ~Ocour <br />0 Ownet'6 & cot1trac;lors Prol. <br />0 <br /> <br />T7 0001153900 <br /> <br />12: OlA-1I.{ <br />6/25/03 <br /> <br />12;OlAM <br />5(25/04 <br /> <br />Glnlr.1 AlIIJrUQ1l1O <br />PtDd4a,,,,,CømplOpIõ AaQrOOil'" <br />Parsøn.lll .. Allv.r1lllng Il1iury <br />e~al1 O¡:curr8ncu <br /> <br />s ONa <br />" 2000 <br />~ 1000 <br />~ 1000 <br />$ 300 <br />$ <br />S <br /> <br />0 <br /> <br />0 OT/'tf:r 1I'i1'1 Umbrella form <br /> <br />Worker$' Compl!"'3Iion <br />."d <br />Emplovers' Liability <br /> <br /> <br /> <br />~ <br /> <br />ALltOlTlOb~ Ie U.bility <br />0 Any ~ulo <br /> <br />BAli OWf1l1d iillltD8 <br />6ol1111dullld aulO6 <br /> <br />0 Hlted 3utoc. <br />0 Nan-owned autos <br /> <br />B Garllge Lillbilily <br /> <br />Excess LlilÞllity <br /> <br />~ <br /> <br />, <br /> <br />1i <br /> <br />E~t I <br />Oc;c;urrance <br /> <br />AQI/roiofj:llll <br /> <br />$ <br /> <br />Pllrtjcìpant <br />Ac;cidcnt <br /> <br /> <br />s <br />SUltutOlY <br /> <br />elch Aeeld",!! <br /> <br />Dlaalu.I"oIICy L'rn'l <br />DI$O~:\ft.I!'CII E.rT1 I ð8 <br />S <br />S <br />3; <br />!Ii <br /> <br />x <br /> <br />DESCRIPTION OF OPERA T/ONS/LOCATION:ãNEt-IICLEs/RESTRICTloNSlSpeCIAL ITCM:! <br />THE CZR'!'IFICATE HOLDER IS NAMED AS 1.DDlTIONAL INSURED PER FORIV/ CG2 02 I). THE <br />A. I. PROMOTES RINK SPONSORED SKATING SCHOOL PROGRAMS. EFFBCTXVE: 6/22/04. TO <br />6 25 04 COVERAGE IS NOT EXTœNDED TO THE EkO OF THE ADDITrONAT. SORBO. <br />CE!RTIFICATE HOLDER CANcEL.LATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POliCIES BE <br />CANCELLED eE;FORE TI'IE EXPIRA1'ION DATE THEREOF, 'rHE <br />ISSUING COMPANY WI~L ENDEAVOR TO MAIL J Q DAYS <br />WRITTEN NOTlC~ TO THE CERTIFICATE HOLDE.R NAMED TO <br />TME LEFT, BOT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE <br />NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />COMPANY,ITS AGENT OR REPREt.sENTATIVES. <br /> <br />CITY OF SANTA ANA RECREA.TION DEPT. <br />ATTN: ROSA FLORES <br />BBB W. SANTA ANA BLVD., #200 <br />SAN'TA ~A. CA 92702 <br /> <br />AlJ'rHORIZEO :It; <br /> <br /> <br />.0 <br /> <br />9 <br /> <br />r. <br /> <br />l0/1ø <br /> <br />39'Vd <br /> <br />SØt>ØC:Z:LØ9L <br /> <br />t>~:LØ <br /> <br />/lÆk <br />t>øøz: /EZ: /9Ø . <br /> <br /> <br />.. <br />