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ACORDTM. CERTIFICATE OF LIABILITY INSURANCE DATE 030812005 <br />PRODUCER Phone: (800) 395 -8075 Fax: (850)519 -08x2 THIS CERTIFICATE IS ISSUED AS A MATTER OF <br />FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION <br />380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />SOLANA BEACH CA 92075 <br />Agency Lic#: OD28716 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Zurich American Insurance Company <br />STKDCLUB '? a)? _ D!y /L <br />INSURER B: <br />JORGE NUNEZ <br />13692 NEWHOPE ST. INSURER C: <br />GARDEN GROVE CA 92843 INSURERD: <br />INSURER E: <br />G(JVtHAUlzb <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 TOWHICH 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. AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILrn <br />INSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MD EFFECTNE <br />DATE MwD <br />Pa yUp"Inow <br />DATe MwOD <br />LIMBS <br />Attention: <br />Je1(rey E. Frick, CEO <br />GENERAL <br />LIABILITY <br />EOL9012327 -00 <br />01101/05 <br />01101106 <br />EACH OCCURRENCE <br />E 1,000,000 <br />K <br />p°RREMSES I"uMmumE °ncel <br />$ 100,000 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE[j] OCCUR <br />MED. EXP (Any one person) <br />$ 2,580 <br />PERSONAL SADV INJURY <br />$ 1,000,000 <br />A <br />GENERAL AGGREGATE <br />j 3000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />_X1 POLICY PRO- LOC <br />PRODUCTS - COMP /(W AGG. <br />$ 3 000 000 <br />AUTOMOBILE <br />LABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accitlent) <br />$ <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />$ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY <br />(Peracritlent) <br />$ <br />PROPERTY DAMAGE <br />Peraca0ent <br />$ <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN E <br />$ <br />ANY AUTO <br />AUTOONLY: AGG <br />E %LE SS / UMBRELLA LIABILITY <br />OCCUR � CLAIMS MADE <br />DEDUCTIBLE <br />APPROV <br />` <br />D AS TO FORM <br />-3 <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />j <br />$ <br />RETENTION$ <br />LBUf <br />I Sh hoedV <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />AB51St3 <br />it City AtIcHnc y <br />ToaV LMRS <br />OTHER <br />E.L. EACH ACCIDENT <br />$ <br />MYPROPREVC)"MTNEMEXECUTWE <br />aPNCE"EMeER EXUUOeor <br />er.a a...a wv <br />aPECU MCVRI*Na e.w. <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE�POUCY LIMIT <br />$ <br />OTHER: <br />DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURE <br />ONLY AS THEIR INTERESTS MAY APPEAR. <br />r FDTICIrAT Un1 MCD <br />25 (2mima) Certificate # 17408 © ACORD CORPORATION 1988 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN <br />City of Santa Ana Recreation <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />ITS OFFICERS, AGENTS, EMPLOYEES <br />REPRESENTATIVES & VOLUNTEERS <br />868 Santa Ana Blvd. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />J <br />Attention: <br />Je1(rey E. Frick, CEO <br />25 (2mima) Certificate # 17408 © ACORD CORPORATION 1988 <br />