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ACORD CERTIFICATE OF LIABILITY <br />INSURANCE DATE (MM OD YYYY) <br />•• [Attn: DUCER (916) 784 -9070 <br />12/09/2003 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />l -Cal Insurance Agency <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />1 Riverside Ave. Ste. #105 <br />ALLTEDRRTHE CIOVERAGEIAFFORDED BY THE POLCIIES EXTEND BELOW. OR <br />Nina or Beverly <br />oseville CA 95678- _ <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER A :NOn rOf3_t Ins Alliance <br />California Hispanic Commission On Alcohol <br />& Drug Abuse <br />w BsuHER: <br />B <br />INSURER <br />2101 Capitol Avenue <br />INSURER O'. <br />Sacramento CA 95816- <br />INSURER E. <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT <br />WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS <br />SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR ADD'L <br />LTR <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE(MM /DO/YYI <br />POLICY EXPIRATION <br />DATE (MMVDD/VY) <br />A <br />X <br />GENERAL LIABILITY <br />LIMITS <br />X <br />EACH OCCURRENCE $ 1,000,000 <br />COMMERCIAL GEIJERA.L LIARUTt <br />DAMAGE TO RENTED) <br />CLAIMS MADE YOCCUR <br />2003 -03026 <br />PREMISES�Ea occurrence) $ 50,000 <br />11/18/200311/18 <br />/2004 <br />X PROFESSIONAL LIAB. <br />MED EXP(Any one Person) S 5,000 <br />PERSONAL B ADV INJURY 5 1,000,OOD <br />X <br />IMPROPER SEXUAL COND <br />GENERA:. AGGREGATE $ 2,000, -DOD <br />AGGREGATE LIMIT APPLIES PER <br />XX <br />X POLICY JECT LOC <br />I / <br />PRODUCTS - COMP /OP AGG 8 2,000,000 <br />A, <br />X <br />AUTOMOBILE LIABILITY <br />/ I <br />IMPROPER SERVAL COND 250, OOO <br />ANY <br />COMBINED SINGLE LIMIT <br />AUTO <br />(Ea accident) 5 1,000,000 <br />ALL OWNEDAUios <br />X SCHEDULED AUTOS <br />2003 -03026 <br />11/119/2003 <br />11/18/2004 <br />BODILY INJURY <br />(Per person) $ <br />X HIRED AUTOS <br />X NON- OVNED AUTOS <br />r2OD I LY INJURY <br />Per accident) S <br />� <br />X COMP: $250 <br />/ / <br />/ / <br />- <br />X ! <br />COLLISION: $500 <br />PROPERTY DAMAGE <br />(Per accident) S <br />GAPAGELIABILITY <br />ANY AU TO <br />AUTO ONLY - EAACCIDENT $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: <br />A <br />X <br />EXCESSIUMBRELLA LIABILITY <br />2003- 03026UMBREI.LA <br />11/18/2003 <br />11/18/2004 <br />AGG S <br />X OCCUR ICLAIMS MADE <br />EACH OCCURRENCE $ 4,000,000 <br />_ <br />!� 't ) <br />a <br />'AGGREGATE <br />g 4,000,000 <br />DEDUCTIBLE <br />_ <br />/ <br />$ <br />RETENTION S <br />r4> — <br />-_ -,.- .. <br />WORKERS COMPENSATION AND <br />EMPLOYERIPCRIDTY <br />LISA `' <br />/ / <br />/ / <br />$ <br />VICSTATU- OTH- <br />TORY <br />ANY IETOWPARTNER/EXECUTIVE <br />OFFICER/MEMBER <br />fi�SSISt8C7 ). <br />LIMITS ER . <br />E.L. EACII ACCIDENT <br />EXCLUDED? <br />/ / <br />/ / <br />c <br />yes, e mbn <br />If yes, describe under <br />� <br />E.L. DISEASE - EA EMPLOYE 8 <br />SPECIAL PROVISIONS below <br />O <br />OTHER <br />E.L. DISEASE - POLICY LIMIT S <br />/ / <br />/ / <br />DESCRIPTION <br />OF nPFRLTinuvi n <br />------ — - -••— uuc� Pr ervuVttStMI,NTISPECIAL PROVISIONS - <br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS <br />FUNDING SOURCE TO THE INSURED. FORM CG 2026 — FONDER APPLIES AS WELL AS EXHIBIT B (ATTACHED). <br />( ) ( ) SHOULD` ANY IOFY THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL X'p�1�CQ( MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, MY" <br />CITY OF SANTA ANA WIC /YD) <br />ANABELL BATES <br />P.O. BOX 1988 —M -73 AUT RIZED REPR ENTATME <br />SANTA ANA CA 92701 - <br />A(qCORD 25 (2001108) ©ACORD CORPORATION 1988 <br />P(�rn INS025 (0108).05 ELECTRONIC LASER FOR - (800)327 -0545 <br />Page l of 2 <br />