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<br />Page I of I <br /> <br />Certificate of Insurance <br />Sparta Program <br /> <br />A- ,;;wO;l-10..L <br />A-~ RIXY!- 1;1 I <br /> <br />Name Insured: <br /> <br />Annas, Abel <br />33 Antibes <br />Laguna Niguel, CA 92677 <br /> <br />Named Additional Insured: <br />SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 9270 I <br /> <br />Certificate # <br /> <br />Coverage <br /> <br />Limits <br /> <br />Deductibles <br /> <br />Terms & <br />Conditions <br /> <br />Exclusions <br /> <br />SSA03-0022 <br /> <br />SPARTA INSURANCE PROGRAM: Commercial General Liability - Hazard 2 <br />Contract Value: $20,000.00 <br />Coverage Period: 8/28/2004 to 8/28/2005 <br />Insurance Carrier; Essex Insurance Company <br />Master Policy: 3CM4080 <br />Master Policy Effective Date: 11/15/2003 to expiration <br /> <br />$2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Completed operations / <br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage / Medical Payments Excluded <br /> <br />$500 BI & PO Per Claimant Including Loss Adjustment Expense <br /> <br />$950.00 Premium (Fully Earned) <br />$29.69 Taxes (Fully Earned) <br />$50.00 Certificate Fee (Fully Earned) <br />TRIA <br /> <br />$1,029.69 <br /> <br />Total Amount <br /> <br />I. No Cancellatlons Allowed. Premium, taxes and fees are fully earned at inception. <br />2. Operations and Rating Based: Consultant - Hearing officer, @ the alternative abatement hearings. <br />3. Department of Planing & Building; Santa Ana PO Animal Services <br />4. Additionallnsured(s); Not Applicable <br />5. No Professional Liability Coverage provided. <br /> <br />Asbestos, Assault & Battery, Employer Related Practices, Subsidence, Independent Contractors, Pollution, Cross <br />Suit, Lead or Silica Dust, Mold or Bio-organic Growth or Mildew, Punitive Damages, Animal, Breach of Contract, <br />Y2K Electronic Data, Medical Payments, War or Terrorism. <br />The insurance provided under this policy is limited to your work performed on behalf of the entity named as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or your <br />organization. Coverage is limited to the description of operations and rating bases listed in "Terms & Conditions" <br />item 2. <br /> <br />Per the Master policy, a copy is available by written request to: Municipality Insurance Services, [nc., 302 W. <br />Cerritos Ave., Building #7, Anaheim, CA 92805 <br /> <br />~~ <br /> <br /> <br />Carol Frost / President <br />Municipality Insurance Services, Inc. <br /> <br />302 W. Cerritos Ave Bldg# 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-[ 100 fax (714) 687-1106 LicensesCA;OC04849; OR: 195423 <br />Website address www.2sparta.com <br />