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A00Ri7 ' CERTIFICAT6,oF LIABILITY INSURAN( s OP ID R DATE (MMDD 0374688 04 15 /03 03 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS KWATTER OF INFORMATION PRODUCER CONFERS NO & Wellness Insurance HOLDER. THIS H S CERTIFIC TIE DOES NOT AMEND, EXTEND OR Agency Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 380 Stevens Ave., First Floor PREMISES(Eaaccurence 5100,000 Solana Beach CA 92075 Phone:800- 395 -8075 Fax:858- 519 -0822 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Specialty National Insuranc 53,000,000 STXD Club 0374688 ��77�� INSURERS: Jorge Nunez 2QV'' Effective: 1/1[03 N INSURER C: GEN'LAGGREGATE LIMIT APPLIES PER: 13692 Newhope t. INSURER D: INSURER E: POLICY JECCT LOC Garden Grove CA 92843 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rim LTR A A 011M NSR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE J OCCUR X Nisc.Professional POLICY NUMBER 3XZ126451 -02 PATE MMIDDIYY 01/01/03 DATE MMID 01/01/04 LIMITS EACH OCCURRENCE $100,00000 PREMISES(Eaaccurence 5100,000 MED EXP (Any one person) s2,500 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE 53,000,000 PRODUCTS. COMP /OP AGG $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY JECCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Pr person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Par accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG E $ LIABILITY EACH OCCURRENCE $ AGGREGATE TEXCESSfUMBRELLA CLAIMS MADE E WORKERS COMPENSATION AND _ TO LIMITS ER E.L. EACH ACCIDENT S _ EMPLOYERS' LIABILITY E.L. DISEASE - EA EMPLOYE $ ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS belm OTHER A Sexual Abuse 3XZ126451 -02 100,000 300,000 DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT) SPECIAL PROVISIONS APPROVED AS IU FORM *City of Santa Ana, its officers, employees, agents and repreeeatat ves �\ named as additional insured per the attached form CG2010 13/85 O A .LO La heedy Deputy City Attorney rrnu CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SANANAT DATE THEREOF, THE ISSUING INSURER WILLdINNNOWTO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, dM0NgffAdjjjjjWWL The City of Santa Ana* mommom� 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 Jeffrey E. Frick 9) ACORD CORPORATION 1986 ACORD 25 (2001/08)