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AC12RA CERTIFICATE OF LIABILITY <br />INSURANCE <br />12/11/200 ) <br />PRODUCER (949) 553-9700 FAX (949) 553-9797 <br />Westland Insurance Brokers <br />2192 Martin Street, Suite 130 <br />Irvine, CA 92612 <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 Delhi Commnunity Center i-_1('Oj. IV,O <br />505 South Central Ave. !1 x`� Y��/+Is <br />Santa Ana, CA 92707-3504 ,;� Jl'h��- <br />INSURERA: TRAVELERS PROPERTY CAS INS CO <br />36361 <br />INSURER B. Carolina Casualty Insurance Co <br />INSURER C: "REVISED 1/12/04" TO INCLUDE <br />GENERAL LIABILITY <br />INSURERD: DIRECTORS & OFFICERS RENEWAL <br />12/14/2003 <br />INsuRER E: NO OTHER CHANGES OR ENDTS ATTD <br />EACH OCCURRENCE $ 1,000,000 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 />INSR <br />ADD'L <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />LIMITS <br />GENERAL LIABILITY <br />660818X4872-03 <br />12/14/2003 <br />12/14/2004 <br />EACH OCCURRENCE $ 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED $ 100,000 <br />PREMISES IF, <br />CLAIMS MADE O OCCUR <br />MED EXP (Any one person) $ S,000 <br />A <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />POLICY PRO LOC <br />JECT <br />AUTOMOBILE <br />LIABILITY <br />8103123W685-03 <br />12/14/2003 <br />12/14/2004 <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />$ <br />(Ea ecodent) 1,000,000 <br />BODILY INJURY $ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />A <br />BODILY INJURY $ <br />X <br />HIRED AUTOS <br />X <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />ANY AUTO <br />AUTO ONLY. ADS $ <br />EXCESS/UMBRELLA LIABILITY <br />CUP 3289W520-03 <br />12/14/2003 <br />12/14/2004 <br />EACH OCCURRENCE $ 1,000,00 <br />X OCCUR OCLAIMSMADE <br />AGGREGATE $ 1,000,00 <br />A <br />Retained Limit $ 10,00 <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />TWO STATU- OTH- <br />EMPLOYERS' LIABILITY <br />E. L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E . DISEASE - EA EMPLOYE $ <br />OFFICER/MEMBER EXCLUDED'/ <br />if yes, describe under <br />E. L. DISEASE -POLICY LIMIT $ <br />SPECIAL PROVISIONS below <br />OTHER <br />Trectors & Officers <br />3336857-2 <br />01/14/2004 <br />01/14/2005 <br />$1,000,000 Per Claim/Aggregate <br />ggre g ate <br />B <br />$1,000 Deductible <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />he City of Santa Ana is named as Additional Insured as per CN0188(01/96) CGD037(01/99) <br />and Exhibit B attached with respects to the operation of the Named Insured. <br />Except 10 days for Non-payment of Premium. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)tXX%XXNX MAIL <br />Jeff Stevens, Risk Manager "30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />City of Santa Ana KXd(Nd 4X KXifiO(;Y%hXXd(�X <br />20 Civic Center Plaza, M28 ➢(i(AN4XdOW(Ai Xi{BfJtYXXXVMXXXDXXXXXXXXXXX <br />Santa Ana, CA 92701 AUTHORIZED REPRES NT TIME , <br />NLVRU 40 jZUU Iwo) ©ACORD CORPORATION 1988 <br />