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A IM, CERTIFICATE OF LIABILITY INSURANCE DATE . 12/31/20031 <br />PRODUCER (909)587 -2719 FAX (909)587 -6001 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION <br />Anthem Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR <br />42145 LyndTe Ln., N202 <br />Temecula, CA 92591 <br />License 8 0884551 <br />NSURED Boys and Girls Club <br />950 Highland St <br />Santa Ana, CA 92703 <br />rn%1FRDGFC <br />INSURERS AFFORDING COVERAGE <br />INSURERA: Markel Insurance Con <br />INSURER B <br />INSURER C: <br />INSURER D. <br />INSURER E'. <br />NAIC 4 <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />II T. <br />DD' <br />HIS <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEFFECTIVE <br />POLICYEXPIRATION <br />01/05/2005 <br />LIMITS <br />GENERAL LIABILITY <br />8502CY073003 <br />12/20/2003 <br />EACH OCCURRENCE <br />1 1,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PRFUIq <br />E 50, 000 <br />CLAIMS MAOE ❑ OCCUR <br />S 5,000 <br />MED EXP (Anyone Person) <br />A <br />X <br />PERSONAL B ADV INJ DRY <br />$ 1,000,000 <br />GENERAL AGGR EGATE <br />E 3,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMPIOP AGO <br />$ 1,000 000 <br />POLICY PRO <br />JECT LOG <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />1002CYC0730044 <br />12/20/2003 <br />01/05/2005 <br />COMBINED SINGLE LIMIT <br />HE. .I <br />E <br />12000,00 <br />BODILY INJURY <br />(Per person) <br />E <br />A <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per accident) <br />S <br />HIRED AUTOS <br />NON OWNED AUTOS <br />PROPERTY DAMAGE <br />(Peracclden0 <br />E <br />GARAGE LIABILITY <br />AUTO ONLY EA ACCIDENT <br />S <br />ANY AUTO <br />OTH ER THAN EA ACC <br />S <br />S <br />AUTO ONLY: AGO <br />EXCESSIUMBRELLA LIABILITY <br />OCCUR �CLAIMSMADE <br />4602CY0730105 <br />1212012003 <br />01/05/2005 <br />EACH OCCURRENCE <br />E 5,000,00 <br />AGGREGATE <br />$ 5,000,00 <br />A <br />X <br />E <br />DEDUCTIBLE <br />E <br />X RETENTION E 10,00 <br />S <br />WORKERS COMPENSATION AND <br />WC STATU- OTH- <br />EMPLOYERS' LIABILITY <br />ANY PROPMEICHIPARTNER /EXECUTIVt <br />Oyes de/MEMBER EXCLUDED? <br />Ryes dLPRO <br />In <br />1" "G- - --�. L. <br />! �. <br />E. L. EACH ACCIDENT <br />E <br />E.I. DISEASE - EA EMPLOYEE <br />E <br />E . DISEASE -POLICY LIMIT <br />1 <br />SPECIAL PROVISIONS below <br />16IO <br />L. : <br />OTHEs <br />10 Gay cancel non <br />payment of premium <br />DESCRIPTION OF OPERATIONS 1 LOCATION`I VEHICLES <br />F• ri+v ,.F C� +_ ems., — ic <br />I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />____ <br />-_ -------- _ _. .... _ a,R „.,Ile. a. ......anal Insures <br />respects the operations of the named insured. <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />ACORD 25 (2001108) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOr, THE ISSUING INSURER WILL lII)WOOM MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />kwwxkwtkx*xv&1EDcx&woGYIXIXX Auxa(AKo kx)o)txxKYIwtKxX <br />AUTHORIZED <br />© ACORD CORPORATION 1888 <br />lkwa <br />