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<br />Dec .02 02 12:4Sp
<br />Dee 02 02 12,10p
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<br />PRCSA
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<br />5714211
<br />7145268380
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<br />p.2
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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />I'fiooucRt
<br />
<br />Leeds Insurance Services
<br />
<br />~.......,.
<br />1Z/2/02
<br />- -
<br />THIS CERT'FJC.4T~ IS ISSUED AS A MAlTER OF ''''FORMATION
<br />OlH.Y AND CONFIiRS NO RIQHTS U,"ON THe- CERllptCATe
<br />HOLDER_ THIS CERTIFICATE DOES NOT AMeND, EXTEND OR
<br />ALTER THE CO\rERAt:iE AFFORDI:D BY Tile POLICJES BELOW.
<br />
<br />2555 E. Chapman Ave, #604
<br />Fullerton, CA 92831
<br />
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<br />I."ISUIIlR$AFFO~CO\IIII'ACE ,
<br />
<br />IlJURER~. GRaI Divide l~suraDl:eComDltnv .-{
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<br />INSURER ~: . -=.J
<br />
<br />IN$URfo----
<br />EI Rincon Flamenco
<br />
<br />Academy of International Dance
<br />
<br />220 E_ 4th SI., Sle. 202
<br />
<br />I Santa Ana. CA 92701.
<br />
<br />COVI;RAGES
<br />
<br />rTHE POLICIES OFIIISURANCE LISTeD 8El,OW HAVE BEeN ISSUeD TO THE INSUREO NAMED ABOVE FOR THE POLICY INDICATED. NOIWITHSTANOING
<br />. ,""Y ROOUIREMENT. TERM OR CONDITION OF ANY CONlRACT "" OTHER OOC"~ENT WITH RFSPEn TO WHICH THIS CERnFICATE MAY IlIi OS,uEO OR
<br />r: MAY f'ERrAIN. HtE INSU~'\NCE AFFORDED BY THE POLICIES DEsCRIBED HERE~ IS SUBJECT TO All 'l'IiE TE.ltMS. FXCWSIONS AND CONDITIONS OF
<br />!iil SUCH 1)00ICIE:S. AGGq,EGj\n; LIMITS SHOWN "'",Y HAVE BEEN REDUCED BY PAID CLIdMS. _
<br />IIN:;qj---.--,- " POlII;'( toenVl<.
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<br />POL.JCV~'iiZlii"'r~----_
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<br />06.01.03
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<br />I E/lOlOCGURANCE ~ 1.000.00Q
<br />~~...."..._"'-- ,'00.000
<br />MEOl::.IlPII\fIyQl'PGlpc,wm) $ 5.000
<br />_nh:SCll\l,l.l.uov~", '1.0QD.OOO_
<br />~~A:!!..-..l.t.:L2clO.OOO .
<br />~W;;I~~ _$ 1.000.000
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<br />Sf'UWERS"LIMllUTY
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<br />WC:irATV-
<br />TOO.l'U TS
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<br />DBCR\Pl1IllNOFOfIeAAnoNIlU:tcA'T1CINSMHICU!SlEXCWSOlSAtlDa:lItY~ll'RCl\ltstOtrll
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<br />City of S&nta Ana. It. OfIicrs,. Emptoyeoa,. Agents. VoIu"tcera. and Representatives iiIre Hsfl!!d iJS addJtJonaJ Insureds per form
<br />CG2010 (10/01) attached. With raspectto clatmsarislhg aut of the operation and uses performed by cr on beh.lf of the named
<br />insured. such insuranco as i. afforded by this policy J5 primary.
<br />
<br />10 Day NoUce of Cancel for Nonpayment Of Prern.um
<br />C6R.nACATE HOLDER V, ADOITIOMlU..IJIWr;lED: IH!NREAl.ErTER:
<br />
<br />City of Santa Ana
<br />20 Civic Cenl~r Plaza
<br />Santa Ana, CA 92831
<br />
<br />CANCeLLATION
<br />~.;;,,- 0' ". .,...'......... POU'''..:!; ot: C&Nc.eu.eo 81!!I'PIIE Tfft!' tulftMION
<br />DAT'ETtcEREOF, THEISSUltlGJN$URE:ltW.LL_~ r',,"HAIl. 31).._ DAYSWRnTEN
<br />. HOTlCl!!71)THCCl'RTlFII:.II.IICNOlOI!RNAMl!OTOTtlIilLEFT. ~~ ~..~
<br />PJe_ K -"dJI(~t"If'~~llI1:JV'"-h""'~ 1M " i 1 rJI i It
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<br />
<br />AUTHORIlEO~NnT1YE
<br />~..!rans Cal Associat~s
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