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<br />ACOfllY ICERTIFICATE OF LIABILITY INSURANCE ... I Date (mmfddlyy) <br /> 4/5/2006 <br />Prod~ Sandi Fredericksen THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> Wood Gutmann & Bogart Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Al"'fER THE <br /> COVERAGE AFFORDED BY THE POLICIES BElOW. <br /> 15901 Red Hill Ave., uite 100 IN UR A DI R <br /> Tustin CA 92780 <br /> 714505.7000 INSURER Zurich US <br /> www.wgbib.com A <br /> License No. 0679263 <br /> INSURER <br />Insured B <br /> Cathleen Forcucci Dance INSURER <br /> C <br /> 3040 Mary St INSURER <br /> Riverside CA D <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POllCV PERIOD INDICATED. <br /> NOTWITHSTANDING ANV REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br /> TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> POLICY POLICY <br />INSR EFFECTIVE EXPIRATION <br />LTR TYPE OF INSURANCE POLICY NUMBER "~,,.B~~~yy M,.B!;67yY LIMITS <br />f'o. GENERAL LIABILITY EACH OCCURRENCE $ '~ <br /> =:JTERCIAL GENERAL UAB 042823782 121412005 121412006 FIRE DAMAGE (Anv 1 fire) $ <br /> CLAIMS MADE IZJOCCUR MED EXP (An '"' erson) $ <br /> 'Tenant Legal PERSONAL & ADV INJURY $ 1,U' <br /> GENERAL AGGREGATE $ <br /> GEN'l AGG LIMIT APPLIES PER PRODUGTS-GOMP/OP AGG $ <br /> ~-~OLlCY nPROJEG~ [-kOG $ <br />'A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT OOC <br /> ANY AUTO 042823782 121412005 121412006 $ 1,000 <br /> ALL OWNED AUTOS eODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> ~ HIRED AUTOS BOOllY INJURY <br /> NON-OWNED AUTOS (Perilccident) $ <br /> ~ PROPERTY DAMAGE <br /> (Perilccident) $ <br /> :1~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EAACC $ <br /> .,,' ( 'j AUTO ONLY: AGG $ <br /> :]eCESS LIABILITY '/!2; // EACH OCCURRENCE $ <br /> OCCUR 0 CLAIMS MADE j'-f AGGREGATE $ <br /> " $ <br /> =i~EDUCTIBlE l'</~-'f- '-''- .- $ <br /> RETENTION $ .,-.--' --~'-7i,- ;-,_ . .' ..' $ <br /> WORKERS' COMPENSATION & '. !'.;. ., STATUTORY LIMIT '"' <br /> EMPLOYERS' LIABILITY EL EACH ACCIDENT $ <br /> EL DISEASE - EA EMPLOYEE $ <br /> El DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXClUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />City Of Santa Ana and their respective officers,emglo.('eesgagentshvolunteers and representatives are named as an <br />additional insured per attached endorsement 9S2 0 04 9 whic includes primary wording <br />GL Waiver af,Plies per form CG 24 04 10 93. <br />This certifica e suoersedes all others nreviouslv issued. <br />CERTIFICATE HOLDER CANCELLAtiON .. .... .. <br />AIr primary+GL Waiver SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> City Of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL~)f.() MAIL <br /> ~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br /> lEFT,~~)"lll(ll()OOOIj(NlXIl~l!I~ <br /> l!IJ(JWlOO(XI( X~~ <br /> 20 Civic Center Plaza ~X * 10 Davs for Non.Payment of Premium <br /> Santa Ana CA 92701 AUTHORIZED <br /> REPRESENTATIVE ~ .!:rr-"-< ;6~ <br /> Peter Barsky <br />ACORD 25-5(7/97) crElated atwW\IV.eCertsONUNE.com G ACORD CORPORATiON 19 88 <br />