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12- 13 -'04 12:38 FROM- ALL -CAL INSURANCE 9167840158 T -358 P002/007 F -682 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE 1211 IBDOYYYY) <br />12/13/2004 <br />PRODUCER (916) 784 -9070 qA �� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND AIL -Cal Insurance Agency -� - 'L HOLDER, TTHSOCERTTIIFICAOTER DOES NOT AMEND. EXTEND OR <br />$01 Riverside Avenue #105 /� �ye-,� ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Attn: Beverly Al �y"''I�� <br />INSURED mauntnn,.��• <br />California Hispanic Commission on Alcohol INSURER S:NORTH AMERICAN ELITE NS. <br />and Drug Abuse Prevention INSURER C: <br />2101 Capitol Avenue INSURER D: <br />Cnnrwmnnrn CA 95816- INSURER _. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIGAT Eu. NU I WI I Hb IANUINU AN1 <br />REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES <br />AGGREGATE <br />IN9RADD,L <br />LTR <br />INS <br />LIMITS SHOWN MAY HAVE BEEN <br />TYPE OF INSURANCE <br />REOUGED BY PAID ULAIMb. <br />POLICY NUMBER <br />POLICYEFFECTIVE <br />OATF ODIYY) <br />F0UCYEXMRATION <br />DATE(MMIDOYYI <br />LIMITS <br />A <br />X <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />/ / <br />/ / <br />EACH OCCURRENCE <br />3 1,000,0( <br />DAMAGE ;O RENTED <br />PREMI E EaA T.1.1nee <br />' 50, OL <br />MED EXF (AnY one ers0n) <br />$ 5,OC <br />CLNMSMADE ❑X OCCUR <br />2004 -03026 <br />11/18/2004 <br />11/18/2005 <br />PERSONAL &ADV INJURY <br />S 1,000,0C <br />X PROFESSIONAL LIAR. <br />X <br />EMPLOYEE BENIFITS <br />/ / <br />/ / <br />GENERA. AGGREGATE <br />3 2, 000, 0C <br />GENL AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMPIOP AGO <br />S 2, 000, OC <br />ImIRiOPER SEXUAL COND <br />1,000,0( <br />X POLICY F7 JECT LOC <br />A <br />X <br />AUTOMOBILE <br />LIABILITY <br />/ / <br />/ / <br />COMBINED SINGLE UMIT <br />(Ea a46dmt) <br />S 1, On, OC <br />ANYAUTO <br />BOULY INJURv <br />(Per PMGn) <br />S <br />ALL OWNED AUTOS <br />scHEwLEDAUr05 <br />2004 -03026 <br />11/18/2004 <br />11/18/2005 <br />X <br />X <br />SODILYINJIMV <br />(PerevA4an1) <br />S <br />HIRED AUTOS <br />NONOV,NEDAUTOS <br />VL) <br />_.� {` / <br />v <br />/ / <br />• <br />• <br />PROPERTYDAMAGE <br />(Per�mU <br />$ <br />cow DED: $250 <br />c1 <br />t`l` P'.✓ 1 <br />Y�J ?` <br />I / ��- <br />n. <br />/ / <br />X <br />COLLISION DED: $500 <br />GARAGE LIABILITY <br />ANVAUTO <br />` -i'j' OtG <br />ell <br />AUTO ONLY - ERACCIDENT <br />3 <br />OTHERTHAN FA ACC <br />AUTO ONLY: AGO <br />4 <br />3 <br />A <br />X <br />EXCESS/UMBRELLA LIABILITY <br />X OCCUR r7 CLAIMS MADE <br />PSc� \S� <br />!I <br />/ / <br />/ / <br />EACH OCCURRENCE <br />S 4, 000, OC <br />AGGREGATE <br />$ 4, 000, OC <br />3 <br />� <br />3 <br />DEDUCTIBLE <br />2004- 03026Um) <br />11/18/2004 <br />11/18/2005 <br />3 <br />X RETENTION $10,000 <br />- <br />WORKERS OOMPENBATION AND <br />I TVW LIMITS 1 ITP <br />El EACHACCIDENT <br />8 <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOWPARTNER/VECUTIVE <br />E.L. DISEASE - EAEMPLOYEES <br />OFHCERAIEMBER EXCLUDED? <br />/ / <br />/ / <br />E.L. DISEASE - POLICY LIMIT <br />13 <br />It yea, des"ne under <br />SPECIAL PROVISIONS bNOV, <br />B <br />OTHER EMPLOYEE DISHONESTY <br />CWB 000 2271 02 03026 <br />11/18/2004 <br />11/18/2005 <br />LIMIT $100, OL <br />FORGERY /ALTERATION <br />Cm 000 2271 02 03026 <br />11/18/2004 <br />11/18/2005 <br />DEDUCTION $5C <br />A <br />DIRECTORS 6 OFFICERS <br />2004- 03026n0 <br />11/18/2004111/18/2005 <br />LIMIT $ 1,000,00 <br />DESOMPRON.OF OPERATONSILOCATIONSNEHICLESIE XGLUSIONS ADDED BV ENDORBEMENTESPECIAL PROVISIONS <br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS <br />FUNDING SOURCE TO TITS INSURED. FORK CG 2026 APPLIES. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EE CANCELLED BEFORE THE <br />ANABELL BATES EXPIRATION DATE THEREOF. THE ISSUING INSURER PALL A)MOS(4MOM MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, INR <br />CITY OF SANTA ANA 1@( 16MtlifXif Xtlt (XMM1t1W0A141t.10{16Y11GNH11E <br />P.O. BOX 1988 M -73 k i@10WLWtSKI(kXDrItiAFXd(K <br />20 CIVIC CENTER PLAZA AU11iOWZ00 REPRESIONIATIVE <br />SANTA ANA CA 92701 - <br />ACORD 26 (2001/08) m ACORD CORPORATION 19 <br />t�_ - INS025(0108).05 ELECTRONIC LASER FORMS,) (800)327 -OW Pege1 <br />