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Page 1 of 1 Certi acate of Insurance <br />Sparta Program <br />Name insured: Named Additional Insured: <br />Achatz, Daniel SANTA ANA (SPARTA) N ,200.2. O~(8 <br />4390 Monte Verde 20 Civic Center Plaza PO Box 1988 <br />Pomona, CA 91766 Santa Ana CA 92701 ~/- 020 0~ - ~ ~8 - ~ ~ <br />/V- ~00~2-OH8-O~ <br />Certificate # SSA06-0038 <br />Coverage SPARTA INSURANCE PROGRAM: Commercial General Liability -Hazard 2 <br />Contract Value: $9,500.00 <br />Coverage Period: 5/22/2007 to 5/22/2008 <br />Inswance Carsier: Essex Insurance Company <br />Master Policy: 3CV8902 <br />Master Policy Effective Date:l 1/15/2006 to expiration <br />Limits $2,000,000 General Aggregate / $1,000,000 Each occurrence / $1,000,000 Products/Completed operations / <br />$1,000,000 Personal & Advertising Injury/$50,000 Fire Damage /Medical Payments Excluded <br />Deductibles $500 BI & PD Per Claimant Including Loss Adjustment Expense <br />$450.00 Premium (Fully Earned) <br />$14.29 Taxes (Fully Earned) <br />$50.00 Certificate Fee (Fully Earned) <br />$514.29 Total Amount <br />Terms & 1. No Cancellations Allowed. Premium, taxes and fees are fully earned a[ inception. <br />Conditions 2. Operations and Rating Based: Instructional services for inmates related to anger management, stress reduction, <br />domestic violence. LESS THAN (30) ACTUAL WORKING DAYS. <br />3. Department. Not Applicable <br />4. Additional Inswed(s): Not Applicable <br />5. No Professional Liability Coverage provided. <br />Exclusions Asbestos, Assault & Battery, Employer Related Practices, Subsidence, Independent Contractors, Pollution, Cross <br />Suit, Lead or Silica Dust, Mold or Bio-organic Growth or Mildew, Punitive Damages, Animal, Breach of Contract, <br />Y2K Electronic Data, Medical Payments, War or Terrorism. <br />The inswance provided under lltis policy is limited to your work performed on behalf of the entity named as <br />"Additional Named Insured" above and doesn't extend itself to any other work performed by you or yow <br />organization. Coverage is limited to the description of operations and rating bases listed in "Terms & Conditions" <br />item 2. <br />Per the Master policy, a copy is available by written request to: Municipality Inswance Services, Inc., 302 W. <br />Cerritos Ave., Building #7, Anaheim, CA 92805 <br />.. ,- Carol Frost /President <br />Municipality Inswance Services, Inc. <br /> <br />302 W. Cersitos Ave Bldg# 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-1100 fax (714) 687-1106 LrcensesCA:OC04849; OR.195423 <br />Website address www.2sparta.com <br />