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r CERTIFICATE <br />')F LIABILITY INSURANr'F <br />UHIt IMNVUUITTTT) <br />PRCDOCER (714)569-2700 FAX (714 <br />PrideMark Insurance Agents/Brokers <br />A Leavitt Group Company <br />1820 E. First Street, Ste.#500 <br />Santa Ana, CA 92705 <br />INSURED Oranae Countv Crazies Inc. <br />909 N. Main St. <br />Santa Ana, CA 92701 <br />nrvc <br />09-3099 THIS CERTIFICATE IS IL ,eD AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />INSURERS AFFORDING COVERAGE I NAIC # <br />INSURERA: Nautilus Insurance Company 117370 <br />INSURER B: <br />INSURER C. <br />INSURER D. <br />INSURER E: <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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />sDO'L <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />UMRS <br />GENERAL LIABILITY <br />NC382365 <br />12/02/2004 <br />12/02/2005 <br />EACH OCCURRENCE <br />$ 1,000,00 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />$ 100,000 <br />CLAIMS MADE a OCCUR <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />A <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG <br />$ Include <br />JECT X POLICY PRO- LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident <br />$ <br />BODILY INJURY <br />(Per person) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per accident) <br />$ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Pwaccident) <br />$ <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />S <br />ANY AUTO <br />$ <br />AUTO ONLY: AGG <br />EXCESSIUMBRELLA LIANUTY <br />EACH OCCURRENCE <br />$ <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />E <br />E <br />$ <br />DEDUCTIBLE <br />APPROVED <br />AS TO <br />FORM <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORTARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />tauta <br />WCSTATU- OTH- <br />E.L. EACH ACCIDENT <br />E <br />SIiLI SI]C <br />dy <br />E.L. DISEASE -EA EMPLOYE <br />$ <br />If yes. descnbe under <br />SPECIAL PROVISIONS below <br />ASSiaUL <br />City AtL <br />ineV <br />E.L. DISEASE -POLICY LIMIT <br />b <br />OTHER <br />DESCRIPTION OF OPERATIC ONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />0 days Notice of Cancellation for Non Payment of Premium <br />City of Santa Ana, its officers, agents, employers & volunteers are named as additional insured per <br />Endorsement Forthcoming from the carrier. <br />r IPOTICIr ATC AnI ITCD rwuno 1 n <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL KaM1i)W{fXl MAIL <br />City of Santa Ana <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Community Development Agency <br />XX�a000�XKx����KXd(KKL�41NfYiJN€XDD(IYa(i(XX <br />P.O. Box 1988 <br />kx"X*XUXd(X13(:7(el(4(dfwkxxmxxxKKikIkXw"AxuXXXXXXXXX <br />Santa Ana, CA 92702-1988 <br />AUTHORIZED REPRESENTATIVE �� 2 <br />Jack Wells/ESTHER 101' <br />ACORD 25 (2001/08) ©ACORD CORPORATION 1988 <br />