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<br />IV- 20[)7 -04b <br /> <br />~coi}y ICERTIFICATE OF LIABILITY INSURANCE Ollte(mmlddlyy) I <br /> 1/2/2008 <br />Producer Bobbie Delki 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 ALTER THE <br /> 15901 Red Hill Ave., uite 100 COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Tustin CA 92780 <br /> 714 505.7000 INS~RER Maryland Casualty Company <br /> www.wgbib.com <br /> License No. 0679263 INS~RER <br />Insured INS~RER <br /> Cathleen Forcucci Dance <br /> Academy, Fullerton INS~RER <br /> 3040 Mary St INSURER <br /> Riverside CA 92506 E <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED Bt:.lOW HAVE BtEN ISSUEu 10 THE IN::JUl!tl? NAMt.Ll pBOVE FOR THE POLICY PERIOD INDICATED. <br /> NOlWlTHSTANDING ANY 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 POLlCY <br />INSR EFFECTIVE EXPIRATION <br />TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS <br />LTR <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br />A D~MERC'AL GENERAL LIAS PPS42823782 12/4/2007 12/4/2008 FIRE DAMAGE (An one rlfC) $ 11 <br /> CLAIMS MADE [lJOCCUR MEDEXP (Anvone erson) $ 000 <br /> "Tenent LeQI [ PERSONAL lit ADV INJURY . 1.000 0 <br /> GENEML AGGREGATE $ <br /> h~'l AGG lIM~PLlES~~ PRODUCTS-COMP/OP AGG $ <br /> POLICY ROJECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />A ANY AUlD PP842823782 12/4/2007 12/4/2008 $ 1 000 000 <br /> I- ALL OWNED AUTOS BODlL Y INJURY <br /> ~ SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NQN.{)WNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE <br /> (Per accident) $ <br /> pRAGE LIABILITY AUTO QNL Y . EA ACCIDENT $ <br /> ANY AUTO OTHER THAN fAACC S <br /> AUTO ONLY: AGG $ <br /> =.J;CESS LIABILITY EACH OCCURRENCE $ <br /> OCCUR 0 CLAIMS MADE AGGREGATE $ <br /> =4~EDUCTlBlE $ <br /> $ <br /> RETENIIDN $ $ <br /> WORKERS' COMPENSATION & STATUTORY LIMIT TH' <br /> EMPLOYERS' LIABILITY El EACH ACCIDENT $ <br /> EL OISEASE. EA EMPLOYEE $ <br /> El OISEASE . POLICY LIMIT $ <br />DES :RIPTlON OF OPERA TlONSJLOCA TIONSNEHICLESIEX 'ENOUR,cMENr. ,PECIAL ,,"OV"" " <br />City of Santa Ana and their respective officers, 8mrlo~ees, a~entsl volunteers and representatives are named as an <br />as an additional insured ~er attached endorsemen C 202 0704. primary wording, GL per form 982001 04 99 <br />Waiver applies per form G 24 04 10 93 <br />This certificate supersedes all others previously issued. <br />CERTIFICATE HOLDER CANCELLATION <br />All + 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 ENDEAVOR TO MAIL <br /> ~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOlDER NAMED TO THE <br /> LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION <br /> OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE. <br /> 20 Civic Center Plaza SENTATIVES. -10 Days tor Non-Payment of Premium <br /> Santa Ana CA 92701 AUTHORIZED <br /> REPRESENTATIVE -141yU- <br /> '~l '-1 . .6,. . Jeff Sachs <br />ACORD 25-5 (7/97) I / €)ACORD CORPORATION 1988 <br />