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-J 2- 3- 04;11:48AM;C0MM.DAY.'1IGH- -HOOL <br />FROM Prof Insurers & Assoc FAX NO. : 3018687719 <br />;7142455063 X 2 _ <br />Ja.... 29 2004 01:03PM P2 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE 0 9 /220D4 <br />PROWLER (301)856 -1810 FAX 301 - 868 -7719 <br />Professional Insurers &Associates, Inc. <br />Insurance Agents & Brokers <br />7700 Old Branch Avenue, E -104 <br />Clinton, MO 20735 -1658 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />BOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />iwmw Orange County A Llmane <br />Chartered Chapter Delta Signs Theta Sorority <br />C/0 Dr. DeVera H. Heard <br />PO Box 6523 <br />An eim Hills CA 921114-0523 <br />NGURERA: St. Paul Fire And Marine Insurance Co. <br />$SURERR Twin City Fire Insurance Co. <br />01"Ma <br />INSURER <br />INKIRCRE <br />THE POLICIES of INSURJWCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDA60VE FOR THE POLICY PERIOD INDICATEO. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCVAOENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE WSVED OR <br />µ4y PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />pOLICIEs. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAMS. <br />SR <br />TYPE OF INSVKAWE <br />POLICY NUMBER <br />EFFECTIVE <br />IMF M RATIO <br />11MRS <br />GENERAL LMBIUTY <br />03800353 <br />12/01/2003 <br />12/01/2004 <br />EACH DCCuRRENcE <br />$ 1,000,00 <br />FlRE DAMAGE (My Pro W&) <br />f 300,000 <br />X COMMERCIAL GENERAL W H TY <br />CLAIMS IMDE O OCCUR <br />MED EXP (Any me R N <br />$ 51008 <br />PERSONAL B ADV $JURY <br />f 1, 000 <br />A <br />GENERAL AGGREGATE <br />S 2,000 0OOO <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS- COMPIOPAGG <br />f 21000,000 <br />POLICY PACT loC <br />AUTOMOBILE <br />LMMITY <br />ANY AUTO <br />CONB$ED 5$GLE LIMIT <br />(Es M:O dw <br />S <br />BODILY INJURY <br />(Pa Pc(60nN <br />f <br />ALLOWNEDAUTOS <br />GCHEDVLEOAUTOS <br />BODILY INJURY <br />(Pe,w .M) <br />S <br />HIRED AVTOR <br />HONINW50 AUTOS <br />PROPERTY OAr GE <br />S <br />"RAGE LIABILITY <br />AUTO ONLY. EA ACCIDENT <br />S -- <br />OTHER THAN EAACC <br />AUTO ONLY: AGG <br />S <br />ANY AM <br />S <br />EXCFSSLIANUTY <br />X OCCUR F�CI.AW4 MADE <br />CK03800353 <br />12/01/2003 <br />12/01/2004 <br />EACH OCCURRENCE <br />S 5, 000, Ow <br />AcGREDAT6 <br />$ 5,000,00 <br />A <br />T <br />DEDUCTIBLE <br />s <br />ARTRJTION s <br />S <br />8 <br />WORKERS COMPENSATION AND <br />EMPLOYERS LIABILITY <br />2WBIH2794 <br />04/08/2003 <br />04/0 3/2004 <br />TORY L�r�s E0. <br />EL. EACH ACCIDENT <br />f 100, <br />EL DISEASE - EA EMPLO <br />S 100,000 <br />OTHER <br />C.I. DISEASE. POLICY LIMIT f 500,0 <br />_ <br />DESCRIPIION OF OPEHATIONSA .00ATIONSMEINCLESIEXCLVSpN4 ADDER) BY EIfDORSEAETDISPCCMI FYtOVISTON3 <br />r. Betty Shabazz Delta Academy being held September 2003 -June 2004 at Second Baptist Church, <br />ity of Santa Ana, its officers, Agents, Employees and Volunteers are named as additional insured as <br />aspects their interest in connection with the named insured. <br />CERTIFICATE HAI nrP I I -- ----- ...... �...�...._.___. —__ ....._ –.. ___.. <br />City of Santa Ana -CDBG M -25 <br />Community Development Agency <br />PO Box 1988 M -2S <br />Santa Ana, CA 92702 <br />LI.. _ <br />SHOULO ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL III MAR. <br />30 RAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />- -._._ . Ild ®EYdildHllWLd061pW0Cd(ili(i6t0C <br />J <br />