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Mar 17 05 11:12a Boys & Girls Club Of Sant 714 - 565 -1099 <br />/ply Number. <br />p.2 <br />Oat* EnbDwL 3JI612005 <br />ACQR�L CERTIFICATE OF LIABILITY INSURANCE <br />3/16/2003 <br />maum aerwwxtxoarm Imsurance ads <br />22912 Peaifia Park Or 0200 <br />Ali" Viejo, CA 92656 <br />i94Bi215 -3431 <br />123 656 <br />7NI8 CERnIFICATE 15 ISSUED AS A � MATTEN CP INFORMATION <br />OHLV AND CONFERS NO RIGHTS UPON THE[ CERTIFICATE <br />MOLDER THIS CERTIFICATE DOEIII NOT AMEND EXTEND OR <br />ALTER THE COVERAGE 8EMM BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIL• <br />MW0 Boys L Girls of ssnta Ana, CA 92703 <br />Soya 6 Girls Of Banta Ana Foundation <br />950 W. Highland <br />Aanta Ana, CA 92103 <br />rauRAX Ak"larx Snsurs0ss CAMP <br />AASn <br />A <br />X <br />*a4AN.AIAAlA1Y <br />COAMs;Ac *ugxm,AA,11uK <br />CIAAft A amll <br />oswm+a <br />1/1/2006 <br />ngcClflfEnra <br />OEM D. <br />^ ea <br />30,000 <br />"sump E: <br />9!"MoL Mp AAN <br />f 1,000,000 <br />CnvFMUxeA <br />THE POUCIES <br />ANY REQUIREMENT. <br />MAY PERTAN, <br />POLICIES. <br />OF INSURANCE LISTED BELOW NAVE SUN ISSUED TO THE INSURED NNMw MOVE FOR THE POLICY PERIOD PNIICATEO. NOTMINIMI WOIN s <br />TERM OR CONWON (WARY CONTRACT OR OTRER DOCUMENT WITH RESPECT TO MO NTHIS CERTWCATE NARY BE ISSUED OR <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBWECT TO ALL r TERMS. EXCWSWpS AND CONESTION50F SUCH <br />AOORECATE AABTS SHOWN MAY HAVE BEEN REDUCED SY PAD CLAMS. <br />and ftP1Qyaaa COAL N25 P.O. sox LOSE <br />Sams t., Ca 92702 <br />rau*t <br />2/L/2005 <br />"' <br />AASn <br />A <br />X <br />*a4AN.AIAAlA1Y <br />COAMs;Ac *ugxm,AA,11uK <br />CIAAft A amll <br />6010798273 -05 <br />1/1/2006 <br />ngcClflfEnra <br />f 1,000,000 <br />^ ea <br />30,000 <br />f 3, 0 <br />9!"MoL Mp AAN <br />f 1,000,000 <br />CEMXA!rIMEOAM <br />3.000,000 <br />0@n <br />rOUm <br />rBUMTANN1B <br />LOC <br />pROOUCra.Sow" As, <br />A1,000,090 <br />FL <br />X <br />A"°'O0°` <br />UAMI" <br />ANYAFIO <br />Au ONnavA as <br />SGIEOUlG0AUN05 <br />NONOMMAUV6 <br />10- 0179Y247 -05 <br />1/112005 <br />1/1/2006 <br />marNEOafNaelabT <br />AA anafNj�. <br />11,000,0000 <br />ATOArauutY <br />P'awroV� <br />— <br />1 <br />Y Y <br />aA01rN I <br />1 <br />(ANAaWANDAMAGE <br />AAAIAOAIMRnY <br />A v^"o <br />Y', A(xEMaI <br />A <br />EyrNAA1 EAACC <br />AUf*OL4M <br />f <br />3 <br />A <br />�/ <br />X <br />MIL44MMSIKLAALAVIIIfY <br />occln F Cc --MADE <br />,10,000 <br />- 5Y09 - <br />APPRO <br />1 i /2004 <br />ED AS <br />2/212006 <br />O FORM` <br />c.clVatt9Hafi+ox <br />*J, 00 QUO <br />AGORP14110 <br />r 00, <br />F <br />I ops"COAaM IMPAC 1A M <br />sA*%=WUAaM <br />e r.cA. naow <br />- <br />Eh LL9PFNr <br />! <br />Ira Stio <br />edy <br />ei dazes! o iMrta <br />onMR <br />As I <br />unL k4ly A <br />orrrey <br />aaPNMNW OIOraRFTRIa,la0A11pI1t AYAMRtBr aCLS1 .Pd AmmwASOOafaNarr arWALPlnuswc <br />A8: Certificate Bolder is need as additicaul insured as rsapeoha 11Ae upelatiaeaief f1.o named iRBOSed. <br />CERTIFICATE VOIDER CANCELLATION <br />The City of Santa Ana, Th. s ane <br />Aletlsvelopaant Apaaay, 1u, Offiaan, Agxatx <br />fOOMD AaI wm mlp Asaw O roucai a OANeaLvE DOOM m S0414AMON <br />RATE rIMRNM, m RAVM4 nnMlAll WILL NNL go BAVe NMTAa <br />MNIOa tD Tne olmreMA AaA9r11 aaMe taro LSrr,BP� <br />and ftP1Qyaaa COAL N25 P.O. sox LOSE <br />Sams t., Ca 92702 <br />AiIM01®OMIRaFxTATV4 <br />ACORD 28 MMAXI) <br />EG /T0 AWA <br />33WM.LIzER.M <br />NO <br />6859- 9TL -6P6 Qz:TS 92QZ /4T /EB <br />