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<br />N- 20{)7 -04b <br /> <br />1.c~Rb~ ICE RTIFI CATE OF LIABILITY INSURANCE Dale (mmldd/yy) <br /> 1/2/2008 <br />Producer Bobbie Detki THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> Wood Gutmann & Bosart 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 /> 714505.7000 INSURER Maryland Casualty Company <br /> www.wgbib.com A <br /> License No. 0679263 INSURER <br /> R <br />Insured INSURER <br /> Cathleen Forcucci Dance r. <br /> Academy, Fullerton INSURER <br /> n <br /> 3040 Mary St CA 92506 INSURER <br /> Riverside E <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br /> NOTWITHSTANDING 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 POLICY <br />INSR EFFECTIVE EXPIRATION <br /> TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS <br />LTR <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 <br />A Itp;MERCIAl GENERAL L1AB PPS42823782 12/4/2007 12/4/2008 FIRE DAMAGE (Anv one f~c) $ nf1f <br /> 17 CLAIMS MADE 00CCUR MED EXP (Anv one nerson) $ JU 000 <br /> ~ *TenantLegl [ PERSONAL & ADV INJURY $ ~. <br /> GENERAL AGGREGATE $ <br /> ~N'l AGG LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ <br /> hpOllCY r'PROJECT n lOC $ <br />A ~UTOMOBILE LIABILITY PPS42823782 12/4/2007 12/4/2008 COMBINED SINGLE LIMIT $ 1 000 000 <br />f- ANY AUTO <br /> _ All OWNED AUTOS BODilY INJURY <br /> 7' SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> !... NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE <br /> - (Per accident) $ <br /> ~~RAGE LIABILITY AUTO ONLY - EA ACCIOENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS LIABILITY EACH OCCURRENCE $ <br /> :::::J OCCUR 0 CLAIMS MAOE AGGREGATE $ <br /> $ <br /> ~~EDUCTIBLE $ <br /> RETEN liON $ $ <br /> WORKERS' COMPENSATION & TSTATUTORY LIMIT T OTHER <br /> EMPLOYERS' LIABILITY El EACH ACCIOENT $ <br /> El OISEASE - EA EMPLOYEE $ <br /> El OISEASE . POLICY LIMIT $ <br />DES ;RIPTION OF opERA TIONS/lOCA TIONSIVEHIt.:LEs/EXt.:LUSIONS Auu~u .NUORSlMENT 'SPECIAL PROVTSR: ~s <br />City of Santa Ana and their respective officers, emflo~ees, aJlents, volunteers and representatives are named as an <br />as an additional insured ~er attached endorsemen C 20 2 0704. primary wording, GL per form 9S2001 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 for Non-Payment of Premium <br /> Santa Ana CA 92701 AuTHORIZED <br /> REPRESENTATIVE ~,f1rd-- <br /> j' <br /> '.~ 1-~-1., J: __ ,j /, ; Jeff Sachs <br />ACORD 25-$ (7/97) I / €>ACORD CORPORATION 1988 <br /> <br />