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<br />May, E, 1llE ':20)~ <br /> <br />5 row n & 8 row r [n c <br /> <br />(0,24 [ [ <br /> <br />p. 2 <br /> <br />BJR <br /> <br /> CERTIFICATE OF INSURANCE , ~DATE~ <br /> 1131687 5/04/05 <br />PRODUCER THIS CERilFICATE IS ISSUEO M A MATTER OF INFORMATION ONI.,.Y <br /> K & K Insurance Group, Inc. AND CONFERS NO RIGHTS UPON THE CERTIFICAiE HOLDER rl-flS <br /> 1712 Magnavox way CERTIFICATE DOES NOT AMEND. ~TEND OR ALToR THE <br /> P.O. Box 2338 COVERAGE AFFORDeO BY THE POLICIES BELOW. <br /> Fort. wayne I In 46801 <br /> COMPANIES AFFORDING COVERAGE <br />INSUR.D oL5e-.J 7 ~vi 5 COMPANY A <br /> LEITER GREAT AMERICAN ASSURJ\NCE COMPA <br /> LADIBS PROFESSIONAL GOLF ASSOCIATION <br /> AND ITS MEMBERS tV -.Joo1-oiP7 COMPANY B <br /> lOD INTERNATION~ GO~P' DRIVE LETTER <br /> DAYTONA BEACH, FL 321241092 N<".DO'i-- U"'7-01 COMPANY C <br /> LEITER <br />COVERAGES <br />rHI$ 1$ TO CERTIFY THAT THE POLICIes OF INSURANCE LISTED BELOW HAVE BEEN IssuED TO THE INSUREO NAMED ABOVE FOR THE POLICY <br />PERloP INDICATED, NOTWITHSTANDING MY REQUIREMENT, TERM OR CON01TION OF ANY CONTRACT OR OTHER ooc.UMENTWITH RESPECT TO <br />WHICH THIS CEffnFICATE MAY BE ISSUED OR MAY pe;RTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br />AlL THE TERMS, EXCI.USION$ ANO CONDITIONS OF sUCH POLICIES. UMfTS sHOWN MAY HAVE BEEN REDUCED BY PAID CL.AIMS <br /> . <br />CO, TYPE OF INSURANCE POliCY NUWlER ~!-,CY EFFCCT1\IE POLICY EXPIRATION <br />LTR DATE (r.NIDOIYY) DATE (fNJOOl'(Y) UMITS (;n thouSands) <br /> Gtiln9ral Liability 12,01l\M 12,01AM GMeml AggregQ1e . NONE <br /> A SU Commercial General Uability GL~0568996'00 1/01/05 1/01/D~ Producl~.co~ Aggrq;31e $ 1000 <br /> o Claims Made 1iU0ccu" PersoDal & Adverlif.lng Injlll)' $ 1000 <br /> o Qwr\t:!r's & eontractlYS ~rot Each Occ:urrence . 1000 <br /> 0 Fire DafM!]& (Anyone fire) $ 300 <br /> I Medico] E~nae (Anyone person) $ < <br /> Pal1icipilnl Legal Liabilitv $ 1nnn <br /> AUltImobl1e Uabilly Ct)Il'lblned <br /> DAnyillJto Single . <br /> Limit <br /> BAllovmedautos 6CJdlly <br /> SeheduJed autos Injury =' $ <br /> o HI"'" autos BodIlV <br /> o Non-owned .utos ....juty $ <br /> (rr.r aeeldenO <br /> o Garage Li.biity Property <br /> 0 03mag9 $ <br /> EXCI!!:5S Liability APPROVE ) AS TO Each Ag~rl'!g3te <br /> 0 Occurrence <br /> o Olher lhan UmbreUp form , R1/. I /. . 1ft . $ <br /> Workers' COMpensation ~- Statutory <br /> and V Lau ~~ Sheedy $ El5Ch AcCId~ <br /> Employers' Uability Assist" ity Attorn v $ Dle.ea&e-Policy Linllt <br /> $ Di~aBe-Each 5mgkM!le <br /> AD&D $ <br /> Participant Prlmarv Medical $ <br /> Accident ~Medjcal S <br /> Weeklv Indemnltv S X <br />OESCRIPTION OF OPERA TIONSILOCA'nONsNEJ-ftCLESIRESTRICTIONSlSPECIAL ITEMS <br /> CERTJFICATE HOLDER IS NAMED ADDITIONAL INS~ED AS RESPECTS THEIR INTEREST IN <br /> THE OPERATIONS OF THE NAMED INS~ED. RE: KRlS OLSEN <br /> ACTIVITIES, GOI,F INSTRUCTION LOCATION, RIVERvIEW GOLF C01.lRSE: <br />CERTIFICATe HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE <br /> CITY OF SANTA ANA, ITS OFFICERS CANCE.LLED BEFORE THE EXPIRATION DATE THER~OF, THE <br /> EMPLOYEES, AGENTS, VOLUNTEERS AND ISSUING COMPANY WILL oNDEAVOR TO MAIL 30 DAYS <br /> REPRESRNTATIV.b:;S WRIITEN NOTleo TO THE CERTIFICATE HOLDER NAMED TO <br /> PO BOX 1988 M-23 THE LEFT. BUT FAILURE TO MAIL SUCH NOTiCE SHALL IMPOso <br /> .sANTA ANAl CA 9:nO, NO OBLIGATION OR L1ABIUTY OF ANY Kli UPON THE <br /> COMPANY, ITS AGENTS OR REPRESENTATIIII ~ <br /> AVTHO""'EO .".R""",AT1_ :~(; VI <br />...... / ~J ) '-92 <br /> <: <br />