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10/27/04 WED 13:35 FAX 949 854 0676 DSL SERVICE CO. <br />r40 /27404 10:00 re sou our o?_ <br />pate Issued: 27 -0d.M CERTIFICATE OF INSURANCE <br />AS <br />THE CrrY OF sANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESEr AT P <br />20 CIVIC CENTER PLAZA <br />SANTA ANA` CA OZy07 <br />_iou I UAi tls Alndaur Boxim, Inc. <br />American specialty Insurance smv . Inc <br />dbe USA BArYg <br />142 North Mein meet dba SA 901 Plaza <br />Roanoke, Indiana A6783 Oolaredo SpdnO., CO 50909 <br />This eeru6eate's tasued as a me0ar of TKO BOXING CLUB <br />eartnafion Only and 00rdanl no rVft upon 7n s CENTER STREET <br />the rnrli0vtaholder. This cerliTiak does SANTA ANl4 CA 927M <br />not amend, pdend, or Aerthe coverage <br />Irllardcd by die policy bola-. <br />X002 <br />• rl <br />•.. . »ptt <br />»yq <br />C0 1S TO CERTIFY THAT Tme r � ur m�- _�__ __.__ <br />FOR THE POLICY Pte OO INDICATED, NOT WITHSTANOING ANY RFQUUt£MBRT, TERM OR CONDOION OF ANY GOMTRACi OR ..,. „r <br />DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERM”. THE 05URAMCE AFFORDED B7r 3 POLICIES, :..,..., <br />DESCRIBED HEREIN IS SUBJECT TO ALL THE TEEMS, EXCLUSIONS AND CONDMON OF SUCH POLICIES. AGGREGATE LIMITS 9IIOWN MAY <br />HAVE BEEN REDUCED BY PAID CLAIMS. -w1 <br />GDVEM E 8 IN DOLLARS <br />United Stator Pifellq And Guaranty Company GL PoBry Number 02MOONS General Ap01e9llte 5 ,000,000 <br />ERacdvebl -OCT-0e 7'x07 AM Eapirea'01 -0CT.0012:07 AY P -0�P Op ro" 1:000,000 .. rogjacfelated <br />Pemonal and Advcdhing Injury 1,000.000 <br />Each Occurrence t'000,000 <br />Oalneae to Premises Ronted to You µcry one 50,000 <br />ADDrHO11AL INFORMATION I Kai 1 F46 Iona . - tea...+.. <br />-The CaNticatehclder is ony an Addkional Insured tram roepeet to Ihbllay, =used by the ne00pent Acs& m omtolIt" of the Named Insured. and only wM <br />. <br />respect to supervised dub approved practices, and training of USA Bonrq member Othletes for UEAIBairing sanctioned uV aing, fagardleii aT -homer <br />. Covera0e is excluded for any martial ■Ns. i Ick4=%lna. or OOIor edlvAeo rat specifically approved <br />they are part of a USA dozing sanctioned activity or club adli -ly. "rM <br />- The vtsurance WvGMW provided under this pobcY in DIN MY. <br />. Coverage is effective October 27, 2004 through September 30, 2006. <br />COMPANYI <br />IMPOSE NO <br />Form No. USAB 9013005 <br />Cenlacate No. 100ozisase <br />F7 <br />iO MALL. 90 DAYS WRRiEN NOTICE TO THE <br />ZVO <br />BIJT FAILURE TO MAIL SUCH NOTICE SFIALL <br />David Hence <br />Authorized RepremeruAlive <br />;.Isf <br />w! <br />j <br />"ir} <br />