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<br /> j A-'lOOf)- 16'0
<br /> ~. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIVYYY)
<br /> 06/23/2005
<br />PRO!,"CER (949)263-0606 FAX (949)263-0906 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Co~lete Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />~lifornia DOl #0437762 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW.
<br />l~OOO MacArthur Blvd., PH Flr INSURERSAFFORDlNGCOVERAGE NAIC#
<br />InYine, CA 92612-1447
<br />INS~~~D Trl ::>pan tIne. INSURER A:. American Inter. Specialty Line
<br /> 591 W. Explorer Street INSURER B: Commerce i Industry (AIG-OM)
<br /> " Brea, CA 92821 INSURER c:
<br /> ;
<br /> INSURER D:
<br /> INSURER E: AIG - Denver, CO
<br />C ES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT. TERM OR CONDITION OF AtiY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />~Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TIERMS. EXCLUSIONS AND CONDITIONS OF SUCH
<br />PC/LICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NSR DO' TYPE OF tNSURANCE POLICY NUUBER POLIcY !II'F!CTJVE POUCY !XPlRATlON LIMITS
<br /> I, GENERAL lIABIUTY PROP1956860 03/01/2005 03/01/2006 EACH OCCURRENCE . 1,000,000
<br /> X COMMERCIAL GENERAL lIABILITY DAMAGE 191:'"~ENTED . 100,000
<br /> I CLAIMS MADE m OCCUR MED EXP (Any one person) . 10,000
<br />A X Pollution Liab. PROFESSIONAL LIAB PERSONAL & NJV INJURY . 1,000,000
<br /> X Professional Liab. IS CLAIMS MADE FORM GENERAL AGGREGATE . 1,000,000
<br /> "GEN'L AGGREGATE LIMIT APPLIES PER: RETRO DATE: 3/1/2004 PRODUCTS - COMPfOP AGG . 1,000,000
<br /> I pOUCY n ~~c?i n LOC
<br /> AUTOMOBILE LlA8lLITY CA6439320 03/01/2005 03/01/2006 COMBINED SINGLE LIMIT
<br /> t-y AHYAUTO (EIl!IICddent) .
<br /> 1,000,000
<br /> r- AlL OWNED AUTOS
<br /> r- BODILY INJURY .
<br /> SCHEDULED AUTOS (Per person)
<br />B ex
<br /> HIRED AUTOS BODILYINJURY
<br /> X (p.,8CCIdent) .
<br /> NON.()WNED AUTOS
<br /> I-'"
<br /> PROPERlY DAMAGE .
<br /> (Perac:cidenl)
<br /> GARAGE LIABIUTY AUTO ONLY-EAACCJDENT .
<br /> R AJ('( AUTO OTHERTHAN EA ACC $
<br /> AUTOONL Y: AGO .
<br /> EXCESSlUMBRELLA LIABIUTY PROU1956861 03/01/2005 03/01/2006 EACH OCCURRENCE . 4,000,000
<br /> :!J OCCUR D CLAIMS MADE AGGREGATE . 4,000,000
<br />A .
<br /> ,
<br /> , ~ DEOUCTlBLE .
<br /> X RETENTION $ 10,001 .
<br /> 'WORKERS COMPENSATION AND WC3287982 03/01/2005 03/01/2006 X WC STATU- I"J.\'-
<br /> EMPLOYERS" UASIUTY E.L. EACH ACCIDENT . 1,000,000
<br />B AN'( PROPRIETORIPARTNER/EXECUTIVE
<br /> OFflCERnoIIEMElER EXCLUDED'! E.L DISEASE - EA EMPLCYfE- I 1,000,000
<br /> =~~~~~Sbelow E.L DISEASE - POLICY LIMIT . 1,000,000
<br /> OTHER
<br />DE.PTlON OF OPERATIONS '}.OCATlONS I VEHICL!S I EXC~tS10NS ADOlf ~ EHOORSEMENT' SPEClA~PROVlSIONS .
<br />rDject: TSI049-05 Santa Ana YMCA, 05 W. 'v c Center Dr., anta Ana, CA 92701. The C,ty of Santa Ana,
<br />"ts! officers , agents, i employees are named as additional insureds as respects the general liability
<br />er1form 78025, but only if required by written contract with the named insured prior.to an occurrence.
<br />ubiect to all policy terms and conditions
<br />10jDays Notice of Cancellation for Non-Payment or Non-Reporting.
<br /> ,
<br /> -.. ---
<br />
<br />CERTIFIC EH LDER
<br />
<br />,
<br />~.
<br />['
<br />
<br />CE
<br />
<br />ON
<br />
<br />City of Santa Ana
<br />Downtown Development Oiv~OVm)
<br />305 E. Fourth St., Ste. 201
<br />Santa Ana, CA 92701
<br />
<br />I\~ 1'0
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER W1U ENDEAVOR TO M-"L
<br />30* DAYS WRITTEN NOllCE TO THE CERllFIc.t.TE HOLDER NAMED TO THE LEFT,
<br />F (Ju'( f_URE TO MAIL SUCH NOTICE SHALl IMPOSE NO OBLIGATION OR UABIUTY
<br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES,
<br />AU~EDREPRESENTA~
<br />
<br />!
<br />ACTRD 26 (2001/08)
<br />,
<br />!
<br />
<br />
<br />award Folmar GINNY
<br />
<br />?h.~~
<br />
<br />. i~';'~L:)
<br />
<br />@ACORDCORPORATION1988
<br />
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