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Mar 17 05 11:12a Boys 6 Girls Club Of Sant 714 -565 -1099 <br />ot,a A- AWy- /FoR Nurnbu' <br />p.2 <br />Dow ErEered: 3/16/2005 <br />ASR. CERTIFICATE OF LIABILITY INSURANCE 3716//2000331 <br />,Mum aulfee aauraaee aaa <br />22912 PAai£ia Perk Dr 8200 <br />Aliao W_sja, CA 92656 <br />19491215 -3431 <br />123 456 <br />THIS CERTIROATE 95 ISSUED AS � MATTER OF INFORMATION <br />ONLV AND CONFERS NO RIGHT IIPON THE CERTIFICATE <br />T SCET 3I�7E RHE COVEME W 13Y Y T� EL� OR <br />INSURERSAFFOROINOCOVERAOE <br />NNCa <br />*MOM Soya G Girls of saata RDA, CA 92703 <br />Soya 6 Sirle Of Santa Ana poundation <br />950 W. Highland <br />Rama Ana, CA 92703 <br />y1rlAFAA aWalare na9ran0e CMWN..w <br />urn <br />DUUAENa <br />A <br />ia4wwla <br />euEaAtyMLIry <br />ooIle6ACwalrESALIIIreuTr <br />CRAMS SAGE � occuN <br />0. <br />1./1/2005 <br />R9uaEAe <br />a,Cn OCCUArIEHCa <br />V THE POLICIES OF WSURANCELISTED SELOW HAVE am HWED TO THE INSURED NAMED ABOVE FOR YHE POLICY PERIOD WDICAT=. NDTWONSTAIAWC <br />ANY REOUSIENENT, TEW OR CONDITION OFANY CONTRACT OR OTHERDOCUNENT WOH RESPECT TO VINCH THIS CERTM ICATE MAY 8E ISSUEDOR <br />MAY PERTAW, THE INMMNCE AFPORMffY THE PONCAES DFSCRIIW NEPEIN 18 GUIWECT TOALL r TEWM6. EXCLUSPOOS AND CANMIONS OF SUCH <br />POLICIES. AGGREGATE UNNIT6 SHOM MAY HAVE SEEN REDUCED BY PAD CWSS. <br />10W <br />Imaw- <br />Not <br />DATE TI IN10F, We Orin aMllaN 04- �p�...�. •� N4a 30 Daa wwne <br />AaIOW <br />apTNIE tO TNe QR1RMWa MOIOM NAlra lIYTEEYR 'I <br />and SWP1*yau COW IW25 P.O. Soa 1949 <br />urn <br />asses Aoe. G 92702 <br />A <br />X <br />euEaAtyMLIry <br />ooIle6ACwalrESALIIIreuTr <br />CRAMS SAGE � occuN <br />6040798273 -05 <br />1./1/2005 <br />1/1/2006 <br />a,Cn OCCUArIEHCa <br />41,0 <br />" yy <br />30,000 <br />/ 3 r D <br />� 4jAO *Mpy <br />41,000,000 <br />DENt AOtaa:0A1E <br />row+ <br />wAWAP4Ves PER. <br />4WID. lx <br />+.COIAaTPAaO <br />41,000,000 <br />A <br />X <br />AYf44rMU <br />UNINUTT <br />ANYAOTO <br />ALLDA4EDMR0a <br />9CrIEF0UlL0 AUYDS <br />WFOAUID6 <br />radWWR0AVT06 <br />10- 0179Y247 -05 <br />1/1/2005 <br />1/1/2006 <br />i <br />OOIUNEo*,aEUnT <br />'t,000,0000 <br />- <br />a70M1YYUI.FV <br />fAWrPWeO � <br />4 <br />rm.Y INJURY <br />PY(i:VOSN � <br />.4 <br />rro9eATr0ureE <br />(WS404e111 <br />4 <br />oAa4a444ASaIn <br />MIYAU/D <br />Yr AOOOAWY <br />a <br />aTHERTHVI FAAcc <br />AUWO W1 : ACA <br />l <br />l <br />A <br />Xx <br />sla3sile�4rrlJn• <br />OCCUR ❑Cwas A+ar <br />RETEWON 41o,00a <br />- 5YO9 - 05 <br />APPRO <br />ED AS <br />O FORM; <br />3,000,009 <br />/ r o0,0o <br />i <br />wentmeawnwo mao <br />4w6onar lrwm <br />ANY Pa WADDaNMAnaAO•EfNTAP <br />La <br />' -X/ <br />f/N� -- <br />EL riDpoFNT <br />IS <br />- NEMPIMC! <br />ra Stit <br />edy <br />JG!77 <br />ey <br />auDNleaEparui0JAW0allyal04,Ea1 E119LtlrDIrADaIDaY dOM(METI al6dlLPaWeIOla <br />Ra: Certificate Bolder is need as additional inearad Be raepecta tlw OparStsOAela£ the eased iaaored. <br />s;rnrlrv4.xlc m+AarcrW <br />- <br />/YOra AeY OF WYi Yr9E OwgE®POlKx7Es} EatsiAN�eLLLED ANder THE ENNNRDa <br />'Zbe city of aeeta Ana, the am" <br />DATE TI IN10F, We Orin aMllaN 04- �p�...�. •� N4a 30 Daa wwne <br />sedevolopeent Apeney, Its, OffiaerS. Agents <br />apTNIE tO TNe QR1RMWa MOIOM NAlra lIYTEEYR 'I <br />and SWP1*yau COW IW25 P.O. Soa 1949 <br />asses Aoe. G 92702 <br />AUTHORIZED REWAS MlNa <br />nnsewavvu4 saAA <br />ACORD 25 (=111011) <br />E0 /T0 39VA 372EIO51143438 6055 -STZ -606 OZ:TT 9DGZ /LT /E0 <br />