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<br />03/18/2005 15: 52 FAX 16305980416 <br />, <br /> <br />ALLEN J FLOOD <br /> <br />~005 <br /> <br />. <br />AAIC <br />.....,tc.. A_I"'" a....nc. ClN'par..ton <br />555 CGllege RMd EI!lt <br />PrI"cdoll N.J. ot54t.5Z12 <br /> <br />MEMBER CERTIFICATE <br />COMMERCIAL GENERAL LIABILITY <br /> <br /> Srhedult ur AdditioDJll Insuu:d,'ili; <br /> The below entities an: added DS additiollol msurcd(s) to the certificate :mb)cc\ tolhc: 3chcdulcd applicabl~ additional in;:;ul;Cd <br />j endorsement <br />: <br /> Applicable Additiorwllnsured c:;:ndOrsr:mr;nb mt;:lude; <br /> Form No. Edition Endorsement Title <br /> Dn'~ <br /> CG 20 II 0704 Additional Insl1red~ Lessor of Premise!> (De!leribe Lctl$cd Premises below.) <br /> CG 20 12 0798 Additional In,ured- State or Political SUbdivision-Pa-mitll <br /> (Designate St.:lte or POlitill.ol Subdlvi~ion Below.) <br /> CG 20 15 010' Additionallntured_ Vendors (D~scriM "Your Product" below.) <br />: CG 2028 0104 Additional Insured~ Lessor ofEquJpment <br /> SCHEDULE <br /> Form No. Nume aftd AddR!<i' of AdditionallD.!Iured: Form No. Nllmc nod Addn:s, of AdditioaallJ:uured: , <br /> CC 20 11 Pan Pacific Properties CC 20 15 <br /> PO Box 6000 <br /> San FtfUlCisco, CA 94160 <br /> Desimlltion of Premises (Part Leased to You): ("Y~ur Product'!) <br /> Landlord <br /> CG 20 12 City of San," Ana CG 20 28 <br /> Parks, Recreation & CommunitY <br /> Services Agency - M23 <br /> 888 Wes.t Sanlo Ana Blvd., 2nd Floor <br /> P.O. Box 1988 <br /> Santa Ana, CA 92702 <br /> State or Polilil;:lil Subdivision: <br /> MuniciDality <br />I i <br /> <br />Copyrlg;ht 2004 Amarle_" Alternaotivo rn5I.1r.11"'9 CorporatIon. <br />1I1Clud81i cOPYrighted material of lno Il"ltl.ltQnce Services Office. Il'Ic. with It~ porml"Ion. <br />SRG1100 (08104) Page 4 of 4 <br /> <br /> <br />APPROVED AS TO FOK:n <br /> <br />"---:1::""".' "/ < <br />/ .i) ) . <br />Laura'-<,i~ ~;':cedy <br />J\ssistarll ~._1!\ ,,' ~rney <br />