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<br />. <br /> <br />. <br /> <br />Jul 01 04 OS" ~5a <br /> <br />p.2 <br /> <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 551 DATE (MMfODNYY'i) <br /> SKIDM-l 06/23/04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Cheval Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Lie. OC94257 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. O. Box 2933 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Fullerton CA 92837 <br />Phone' 714-447-9191 Fax,714-525-9191 .'-NSURERS AFFORDING COVERAG~_ ___ _ NAIC# <br />iNSUREO--._u -.---,.-"'-.---- -,,- --_.-- <br /> INSURER ^ AmeriCaIl Bankers <br /> - - ____ __o_____n_. --.-'- .--- --,--'- <br /> INSURER B ___1----- <br /> Cher*l Skidmore .---.--.'- --- --- <br /> Fun i th Horses INSURER C - <br /> _.-- ----- ----- -- - __.___n_"__ <br /> 187 E. W11son St. " INSURER D -----.- <br /> Costa Mesa CA 92627 1--:- -. ------ -- ----,-- <br /> INSURER E <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR Tt-lE POlley PERIOO INDiCATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO Wf~ICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFfORDE.U BY THE POLICIES OESCRIBED 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 /> <br />I~: =!-"'-~YPE O;.INSURA~;__--..----._.POL.ICY NUMBER ~--- <br /> <br />A <br /> <br />_~NER"lllABll1TY <br />X X COMMERCIAL GENERAL. LIA8IL1lY <br />::::.:=- '] CLAIMS MADE ~ OCCUR <br /> <br />- -_.-- .-.- <br />- _.- ---- <br />G~'L AGGRE~E,LlMIT APP~~ES PER <br />X I POLICY I I ~~8-r f =~l- LaC <br />AUTOMOBILE LIABILITY <br />- <br />___ ANY AUTO <br />._ ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br /> <br />SLll03177 <br /> <br />"'POL1CV""E"e~T~ P01.1CYEXJJlRi\fl~-------- -- - .--.. -~ <br />DATE IMMIDDfYYl DATE (MMIOOIVV'j" LIMITS <br />~~gi~.g:~- ~!.' 000 -,.Q.Q.~-- <br />08/31/04 PREMISES(E8ocGUrel'l~L.! 50,090 <br />I_MED EX~ (An~ o""'_~~~)_ .! 5 , 0 ~ O~ <br />~~NAL&ADVI~.JURY . _ ~~.' 000./ 009._ <br />GENERALAGGRE~ATE -----L!. 2 I 09.0, OQ_~ <br />~~ODUCTS_-COMPIOPAC.~ 2_t..2..2.9, 002..- <br /> <br />COMBINED SINGLE LIMIT fl , <br />(l=aar.c1d8nt) <br />-~- -- <br />BOOII Y INJURY $ <br />(Per person) <br />m__ __ --- <br />BOD\L Y INJURY <br />(Peraccidel'lt) <br />-- <br /> <br />08/31/03 <br /> <br />NONE <br /> <br />I- <br />f--. <br /> <br />. <br /> <br />NON-OWNED ....UTOS <br /> <br />-- <br /> <br />PROPERTY DAMAGE <br />(Pllrlleel(lllnl) <br /> <br />. <br /> <br />_O_l"AOE L1ABIUTY <br />_I ANY AUTO <br /> <br />NONE <br /> <br />~~OONLY-EA~CCIDEN~f-S ~ <br />OTHER THAN !:A_A~~ $~_.~____ <br />AUTO ONI y. AGG $ <br />EACH OCCURRENCE $ <br /> <br />ExceSSlUM8RELLA LIABILITY <br />~ OCCUR [] CLAIMS MADE <br /> <br />-, <br />_----I DEDUCTIBLE <br />I RETENTION $ <br />WORKERS COMPENSATION AND <br />EMPLOYER5~UABIUTY <br />ANY PROPRIETOR/PARTNERlEXECUTlVE <br />OFFICERlMEf.ABER EXCLUDED? <br />~~~I~tS~"Ov~~16~s below <br />OTHER <br /> <br />NONE <br /> <br />~G~EGA~,=-- _n_. ~___ __ <br /> <br />--- -- r!------ <br />1--- - -- !. .------ <br /> <br />NOtfE <br /> <br />.IT~Wy1!~W~L_ UR- ____ _ ___ -- <br />_~LEAC~ACCIDENT . _5__.__ <br />E.l. DISEASE - EA EMPLOYEE S <br /> <br />E.L. UISEASE . POLICY LIMIT S <br /> <br />NONE <br /> <br />DESCRIPTION OF OJ>ERATIONS I LOCATIONS /VEHICLES IEXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Certificate holder is an additional insurQd as sponsor of recreation program <br />but only for insureds operation5 under this contraot. <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION / '\ <br /> <br />CITY SA <br /> <br />SHOULD ANY OF THE A OVE ESCRlBEO PDUCIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE I UING NSURER WILL ENIJE.AVOK TO MAIL 10 DAYS WRITTEN <br />NOTICE TO THE CE.,.f1 CATE OL.OER NAMED TO THE LEFT, aUT fAILURE TO DO 80 SHALL. <br />~ <br />Y OF ANY KINO UPON THE INSURf:R, ITS AGENTS OR <br />~ <br /> <br />City of Santa Ana <br />Parks~ Beach and Recreation <br />M 23 Attn: Rosa or Carol <br />PO Box 1988 <br />Santa Ana CA 92702 <br /> <br />IMPOSE NO OBlIG n <br />REPRE.SENTATlvd~ //, <br />AUTHORIZED REPJ ~ ~TI E <br />Cheval ~;rce <br />/ f./-/ <br /> <br />servi~~ <br />V <br /> <br />@ACORD CORPORATION 1988 <br /> <br />ACORD 25 (2001/08) <br />