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/12o)A DRO CERTIFICATE LIABILITY INSURANC' 02/zos PRODUCER (714)979-6543 FAX (714)549-2943 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wi gmore Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2970 HarN3r Blvd. #215 License #0911959 Costa Mesa, CA 92626 INSURED Share Our Selves 1550 Superior Ave. Costa Mesa, CA 92627 INSURERS AFFORDING COVERAGE INSURERA Travelers Property INSURER B: INSURER C: INSURER 0: INSURER E: NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR NDV TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION rRIMMUDDO LIMITS GENERAL LIABILITY 66083OX485003 01/26/2004 01/26/2005 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE a OCCUR $ 5,000 MED EXP (Any one Person) A PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY J JECT LOC AUTOMOBILE LIABILITY ANY AUTO 8103466W344 01/26/2004 01/26/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Par person) It A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC S ANY AUTO $ AUTO ONLY: AGG EXCESSNMBRELLA LABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ S $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER,MEMBER EXCLUDED? r��f,. �;,+� ti �� E.L. EACH ACCIDENT $ El. DISEASE - EA EMPLOYEE $ If yes, descriEe under SPECIAL PROVISIONS W10w E.L. DISEASE -POLICY LIMIT $ OTHER ,., i.... 1 7w, Il,e v DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN CONECTION WITH THE NAMED INSURED. 0 DAYS NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM. CITY OF SANTA ANA ATT: LUCY FLORES P.O. BOX 1988 SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL JWM00M MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, KOWO"0009&W"X&totlklOzlkxKx txxd(xa4NdWfxilGxdt KXNXXXX AUTHORIZED REPRESENTATIVE ACCIRn 25 r9nMInR1 FAX: (714)647- r Arnon rnoonoATInIJ 40AR