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<br />Certificate of Insurance
<br />Sparta Program
<br />
<br />A- ,;wO';)-lwaL
<br />ft- ;;(£0£/ - I,). I
<br />
<br />Name Insured:
<br />
<br />Annas, Abel
<br />33 Antibes
<br />Laguna Niguel, CA 92677
<br />
<br />Certificate #
<br />Coverage
<br />
<br />Limits
<br />
<br />Deductibles
<br />
<br />Terms &
<br />Conditions
<br />
<br />Exclusions
<br />
<br />Named Additional Insured:
<br />SANTA ANA (SPARTA)
<br />20 Civic Center Plaza PO Box 1988
<br />Santa Ana CA 9270 I
<br />
<br />SSA03-0022
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<br />SPARTA INSURANCE PROGRAM: Commercial General Liability - Hazard 2
<br />Contract Value: $20,000.00
<br />Coverage Period: 8/28/2004 to 8/28/2005
<br />Insurance Carrier: Essex Insurance Company
<br />Master Policy: 3CM4080
<br />Master Policy Effective Date:II/15/2003 to expiration
<br />
<br />$2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Completed operations /
<br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage / Medical Payments Excluded
<br />
<br />$500 BI & PO Per Claimant Including Loss Adjustment Expense
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<br />$950,00 Premium (Fully Earned)
<br />$29,69 Taxes (Fully Earned)
<br />$50,00 Certificate Fee (Fully Earned)
<br />TRIA
<br />
<br />$1,029,69
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<br />Total Amount
<br />
<br />I, No Cancellations Allowed, Premium, taxes and fees are fully earned at inception,
<br />2, Operations and Rating Based: Consultant - Hearing officer, @ the alternative abatement hearings,
<br />3, Department: of Planing & Building: Santa Ana PO Animal Services
<br />4, Additional Insured(s): Not Applicable
<br />5, No Professional Liability Coverage provided,
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<br />Asbestos, Assault & Battery, Employer Related Practices, Subsidence, Independent Contractors, Pollution, Cross
<br />Suit, Lead or Silica Dust, Mold or Bio-organic Growth or Mildew, Punitive Damages, Animal, Breach of Contract,
<br />Y2K Electronic Data, Medical Payments, War or Terrorism.
<br />The insurance provided under this policy is limited to your work perfonned on behalf of the entity named as
<br />"Additional Named Insured" above and doesn't extend itself to any other work perfonned by you or your
<br />organization, Coverage is limited to the description of operations and rating bases listed in "Tenns & Conditions"
<br />item 2,
<br />
<br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, Inc" 302 W,
<br />Cerritos Ave" Building #7, Anaheim, CA 92805
<br />
<br />~.~
<br />
<br />
<br />Carol Frost / President
<br />Municipality Insurance Services, Inc,
<br />
<br />302 W, Cerritos Ave Bldg# 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-1100 fax (714) 687-1106 LicensesCA:OC04849; OR: 195423
<br />Website address www.2sparta.com
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