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<br />Ma~ 20 04 02:32p <br /> <br />p.2 <br /> <br />p.2 <br /> <br />/BRANCH <br />21 <br /> <br />BIA <br /> <br />PRODUCER NUMBER IDATE OF ISSU !RENEWAL OR REPLACEMENT Nol <br />0003252 (21.0) . 1212/2003 NEW <br />SPORTS GENERAL LIABILITY POLICY . ,_ -'LJ/),J-osO <br />OCCURRENCE POLICY IV owv"1' <br /> <br />PURCHASING GROUP POLICY NUMBER: GL2-3000101 <br /> <br />Item I DECLARATIONS CERTIFICATE NUMBER: GLS - 2031104 <br />1- , Named Insured Tustin Manial Arts <br /> i . <br /> ! ADDRESS . 7133 Grove Wood lane <br /> NII~, &. 51~el. Town. COlJflty, Slale & lip No . Orange. CA 92869 <br /> Policy Period; From: 11/24/2003 11/24/2004 -- <br />2. To <br /> 1Z;OI AM. S:aJ)ljDIl1Tim~'" L(lCahCrl olPromllioCi D(lG~l'loled in Itam 1 <br /> COVERAGE , LIMITS OF LIABILITY , PREMtUM <br />3. , , <br /> ! I <br /> Soor1s Gef1tlrtllliEtbi~t\' $ 1.000.000 ea<:ttoccurrence : $ 2.000.000 aggregate S 385.(0 <br /> $ 1,000,000 PO:f50~al end AUverh~'f19l.iabihty i $ 2.000,000 PFlJdwc:s . GOmp:f1\lKI Operations AOOlR!Ji!I'l'I <br /> $ 50,000 Fire DliIl1lilQ4{any one nre) 1$ 0 MediCal Expe~" (arly()oo Person) <br /> : Termri:sm Ri:>k In:5untl1ce Act- Certified Acts Cuverage 0 Covered l!J Not Covered S 0.00 <br /> i Minimum Earned Premium $ 300.00 <br />4 I Deductlble $ NONE eMhOCCUrteflct!' <br />5. I R!p~t:atlon: Thl:' Na~ Insurec! r~prl!Sent5 th",= acdOent lnsul<!nce lfl ~ alTl();Jot specified will be In full force and effect of each partjOD/Kllln MY and "illlthletic <br /> progrilms covered by lhl.'i po/JCy. <br /> i Ad:lden~ In~urallCC represented .:moJot: $ 25.000 <br />6. I JtliS polICY ~ wcldt> Clod dCcep{Rf subject to ttle printed cooditiorlS iIllhl$ pOliCy lvgethef wit~ the prolliSiO/ls. stiPttlatlons aM o9rE:e1l'lClltS oXHltain in (he fOllOwUlg <br />(1;1rI'11!;(S) Ot en<!Ori:lelTlet'Tt(s). <br /> I GLO-2065{09/96),CGOOOl (01196J,GLE-2002(12197),GLE-8049(08/99},GLE.201 3(03/00).CG2147(1 0/93),ILOO03(11/85), <br /> I LOOI7(11198).IL0021 (11185),EUE-8050(01 1lI4).GlE-8060(04/00).GLE8023(08I93),GLE8046(12198).CG2135(10IQ3 ),CG <br /> : 2026( 11185), MSE~6001(2/95). ,GL387!l(1103) <br /> i <br /> I CHICAGO INSURANCE COMPANY <br /> EXECUTNE OFFICES: 55 E. MONROE STREET, CHICAGO, ILLINOIS 60603 <br /> REPRESENTATIVE Agent or broker . Midland Insurance Group, Inc. ! <br /> Office Add ress . 1730 Park Street Ste. 207 <br /> City, State, lip . Naperville.IL 60563 <br /> I Additional 2% CA SUlthsr,. $ 'JJIJ <br /> , INTERSTATE <br /> I INSURANC <br /> , <br /> GROtJP <br /> i GLP 2010 {01/0JI <br /> <br />I <br /> <br />r#~d7 <br /> <br />...- <br /> <br />/li:'}- <br />