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,Hi��rcu U tt l IhIcA I F -IF LIABILITY INSURAW <br />'REDUCER (114)569-2700 FAX (,, ,_09-3099 I ERTIFICATE IL f <br />PrideMark Insurance Agents/Brokers ONYCAND CONFERS NO <br />A Leavitt Group Company HOLDER. THIS CERTIFIM <br />1820 E. First Street, Ste.#500 <br />Santa Ana, CA 92705 <br />iSURED Orange County Crazies Inc. <br />809 N. Main St. <br />Santa Ana, CA 92701 <br />CnVFRAnI=Q <br />VF, G IMM1VUUIY T T Y) <br />O"-078 (1 11/30/2004 <br />AS A MATTER OF INFORMATION <br />ITS UPON THE CERTIFICATE <br />)OES NOT AMEND, EXTEND OR <br />INSURERS AFFORDING COVERAGE <br />INSURERA: Nautilus Insurance <br />INSURER 8: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />NAIC # <br />17370 <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 />NSR D' <br />ryPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />12 / / <br />POLICY EXPIRATION <br />LIMITS <br />A <br />GENERAL LiA&LRY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE � OCCUR <br />NC382365 <br />022004 1202 2005 <br />/ <br />EACH OCCURRENCE <br />§ 1,00,00 <br />DAMAGE TO RENTED <br />§ 100,000 <br />1 <br />MED EXP (Any ore person) <br />E 5,00 <br />PERSONAL & ADV INJURY <br />S 1,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2 , OOO, DD <br />PRODUCTS - COMP/OP AGG <br />$ Include <br />X POLICY M JERCOT n LOC <br />ALWOMOBILE <br />UABILWI' <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea acadenq <br />E <br />ALL OWNED AUTOS <br />BODILY INJURY <br />(Per person) <br />E <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY <br />(Per acdtlenl) <br />_ <br />§ <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Pa-ec6danl) <br />§ <br />GARAGE UABIUTY <br />ANY AUTO <br />AUTO ONLY - EA ACCIDENT <br />S <br />OTHERTHAN EA ACC <br />AUTO ONLY: qGG <br />$ <br />EXCESSlUMBRELLA LIABILITY <br />E <br />OCCUR ❑ CLAIMS MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />§ <br />S <br />DETECTIBLE <br />RETENTION E <br />APPR <br />ED AST <br />FORM <br />E <br />WC STATU- OTH- <br />a <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />K yes,de be antler <br />SPECIAL PROVISIONS below <br />OTHER <br />As <br />dy <br />rneV <br />E.L. EACH ACCIDENT <br />§ <br />8Ur8 SLIT SIIB <br />stant City At <br />El. DISEASE - EA EMPLOYE <br />$ <br />EL DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />0 days Notice of Cancellation for Non Payment of Premium <br />ity of Santa Ana, its officers, agents, employers & volunteers are named as additional insured per <br />ndorsement Forthcoming from the carrier. <br />CERTIFICATF Wrll nFo <br />City of Santa Ana <br />Community Development Agency <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <br />ACORD 25 (2001108) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL xlxxXl)DttwXl MAIL <br />30 DAYS WRWTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />KWAUMWOO@L)Mxxa(Iy&)axLAtxatFnl(xdxxl)If)*x71(Ix)xxesxl xxx <br />AUTHORIZED REPRESENTATIVE <br />Jack Wells/ESTHER <br />©ACORD CORPORATION 1988 <br />