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amsmflll Municipality �11/22/2004 2:03 PMMfffteribfLianceSparta ProograM <br />PG3i2i228i88F8182YE1Y1181MWXYd8iG832e"3iE81Y81YlYdYffiGGii286E%E3EPYGWY6Gd82%3i2d@YBbIYdE%idiF38%3F8689tlIG6Y6N8i[w3EF'83EEEP2IYIY'i6MYF3Gi83Ei2F89EkEii$F3iie^u'Fiii23��8YdfHkG6fidii2i33EiEF2'183YY <br />flame Insured: Named Additional Insured: <br />khan, Barbara <br />1056 Madeira Ave <br />:osta Mesa, CA 92626 <br />7ertificate # SSA04-0027 <br />SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br />overage SPARTA INSURANCE PROGRAM: Commercial General Liability - Hazard 2 <br />Contract Value: $10,000.00 <br />Coverage Period: 11/19/2004 to 11/19/2005 <br />Insurance Carrier: Essex Insurance Company <br />Master Policy: 3CP9777 <br />Master Policy Effective Date:l 1/15/2004 to expiration <br />Amits $2,000,000 General Aggregate / $1,000,000 Each occurrence 1 $1,000,000 Products/Completed operations / <br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage / Medical Payments Excluded <br />)eductibles $500 BI & PD Per Claimant Including Loss Adjustment Expense <br />$950.00 Premium (Fully Earned) <br />$29.69 Taxes (Fully Earned) <br />$50.00 Certificate Fee (Fully Earned) <br />TRIA <br />$1,029.69 Total Amount <br />Perms & 1. No Cancellations Allowed. Premium, taxes and fees are fully earned at inception. <br />"ooditions 2. Operations and Rating Based: Consultant - Hearing officer, @ the alternative abatement hearings. <br />3. Department: Planning & Building <br />4. Additional Insured(s): Not Applicable <br />5. No Professional Liability Coverage provided. <br />'exclusions Asbestos, Assault & Battery, Employer Related Practices, Subsidence, Independent Contractors, Pollution, Cross Suit, <br />Lead or Silica Dust, Mold or Bio -organic Growth or Mildew, Punitive Damages, Animal, Breach of Contract, Y2K <br />Electronic Data, Medical Payments, War or Terrorism. <br />The insurance provided under this policy is limited to your work performed on behalf of the entity named as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or your organization. <br />Coverage is limited to the description of operations and rating bases listed in "Terms & Conditions" item 2. <br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, Inc., 302 W. Cerritos <br />Ave., Building #7, Anaheim, CA 92805 <br />Carol Frost / President <br />Municipality Insurance Services, Inc. <br />IYIYIigE919dF1dY9EE399ifidE9E99ffi9FL9fifiBYYG9959ffiBfiiE9Y09ElCWkVEfi39Y9Ef6'aPfi9Sfiffifi9iEBea9iiieiiEfiidfiffidY6eIWIIBYE'd9Efifi996E99fL'BSJk£dsSE9Eiai9esi9s'afBifi9iemi9neiBfiidiifiind86BIY9ktl'J60°5EEffid3iEfifieal3dfiieiiE9tllfiil <br />302 W. Cerritos Ave Bldg# 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-1100 fax (714) 687-1106 LicensesCA:0004849; OR:195423 <br />Website address www.2sparta.com <br />001, <br />