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- A ~ORDTM CERTIFIC'....E OF LIABILITY INSURAP':E I DATE (MMIDDIYYYY) 1 0/1812006 PRODUOER Phone: (800)747-9573 Fax: (303) 422-1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7615 W, 38Th Avenue, Unit 6-109 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND DR Wheat Ridge CO 80033 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American Alternative Orange County Youth Commission INSURER B: 1850 E. 17th Street #218 INSURER C: Santa Ana, CA 92705 . INSURER D: INSURER E: COVERAGES THE POLlOIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING IWY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR 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. INSR I AOD'L I TYPE OF INSURANCE I POLICY NUMBER POUCY EFFECTIVE IPOLICY EXPIRATION' LIMITS LTR 1 N!R): DATE (MMIDDIYY) , DATE (MMlDDIYY) I GENERAL LIABILITY i 76A2GLODOOO 1-01 10/2212006 I 10/2212007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY I I DAMAGE TO RENTED $" 300,000 ""EMISES (Eo OO::UlTOnce) I I CLAIMS MADE I X I OCCUR i ~ED EXP (Any one person) Separate A X INC ATHLETIC PARTICIPANTS I I l>ERSONAL & ADV INJURY 1.000,000 I ~ENERALAGGREGATE 2,000,000 I IPRODUCT5-COMP/OP AGG 1,000,000 I i POLIC1 I;:g: I I LOC I I ~UTOMOBILE UABILITY I OMBINED SINGLE LIMIT F TANY AUTO ! fa accident) I I I I ~ODIL Y INJURY r i I ALL OWNED AlJTOS I i SCHEDULED AlJTOS I ,.Per person) i I I HIRED AlJTOS b I I NON-DWNED AlJTOS I ODI~ Y INJURY ~ kPer accident) ! ~RDPERTY DAMAGE F i I I I I Per accident) I IGARAGE UABIUTY I , IA.lJTO ONLY - EA ACCIDENT '" i I ANY AUTO I I I I ~THER THAN EAACC ~ I I r'-lJTO ONL"Y: AGG I i , IEXCESSf UMBRELLA LlABIUTY I lEACH OCCURRENCE , I OCCUR I I CLAIMS MADE I ~GGREGATE I I ~ I DEDUCTIBLE i I RETENTION $ I i 9; WORKERS COMPENSATION AND , I I';"~:J~~;,.~ I I""",,,, F,PLOYERS' UABILITY YPROpmETO~PARTNE~ECUTIVE E.L. EACH ACCIDENT ACE~MEMBER EXCLUDED? I .L. DI5EASE-EA EMPLOYEE yes, describe under .L. DISEASE-POLICY LIMIT ISPECIAL PROVISIONS below OTHER: I I i i I I I i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS , Youth Mentoring / California Policy Deductibles: $0.00 per each bodily injury 1 $500.00 per each property damage claim. Additionallnsured(s): City Of Santa Ana, All participants, staff and facilities as scheduled with the company are added as additional insured in regardS to the operations of the insured. CERTIFICATE HOLDER City Of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 _/ i- ;......:;. CANCELLATION ~~ ;~' ~~LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, Irs AGENTS OR REPRESENTATIVES . ~~.. _L,I/':~:;.. ~, ~:~ . 'U,"OOQEO'''~~ Bob Leid .~:-. ,~~. I Attention: ACORD 25 (2001/08) @ACORD CORPORATION 1988