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ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE112/2007 YY) <br />PRODUCER Phone: 1540) ]4]-95]3 Fax: 13 031 422-7 2]6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />The Camp Team ONLY AND CONFERB NO RIGHTS UPON THE CERTIFICATE <br />7615 W. 36Th Avenue, Uni[ B-109 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Wheat Ridge CO 80033 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Capitol Indemnity Ins. Corp <br />Asics Southern California Wrestling Academy! INSURER B: <br />Santa Ma WOltpack Freestyle INSURER C: <br />7737 Pitcairn Dr. <br />CA 92626 <br />Costa Mean <br />INSURER D: <br />, INSURER E: <br />Cf1VFrJ Ar:FS <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />INGS <br />LTR AnDT <br />rao TYPE OF INSURANCE <br /> <br />GENERAL LIABILITY <br /> <br />X COMMERCIAL GENERAL LIABILITY POLICY NUMBER <br /> <br />0500216051 POLN:Y EFFECTIVE <br />DATE (MEVODIYY) <br />11/12/2007 PoLICY EXPIRATION <br />DATE (MMDD/Yy1 <br />03/0112008 LIMBS <br /> <br />CH OCCURRENCE <br />DAMAGE TO RENrEO <br />PROMISES (Ea occueencel <br /> <br />1,000,000 <br />100,000 <br /> CLAIMS MADE X OCCUR MED. EXP (Any ane person) 5,000 <br />A <br />X <br />INC ATHLETIC PARTICIPANTS <br />PERSONALSADV INJURY <br />1,000,000 <br /> ENERAL AGGREGATE 2,000,000 <br /> PRODUCTS-COMP/OP AGG. 1,000,000 <br /> POLIO PRO- LOC <br />JECT <br /> UTO MOBILE LIABILRV OMBINED SINGLE LIMIT $ <br /> <br />ANV AUTO Ea acciden0 <br /> ~. ALL OW NED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS Per perwn) <br /> HIRED AUTOS <br />BODILY INJURY <br /> NON-OW NED PUTOS Per azcitlent <br /> PROPERTY DAMAGE <br /> Per azcidenl) <br /> GARAGE LIABILITY UTO ONLY- EA ACCIDENT <br /> ANV AUTO THER THAN EA ACC <br /> UTO ONLY: AGG <br /> %CESS /UMBRELLA LIABILRY ACH OCCURRENCE <br /> OCCUR CLAIMS MADE GGREGATE <br /> <br /> DEDUCTIBLE <br /> RETENTION$ <br /> ORXERSCOMPENSATION PNO <br />W C STATU- <br /> NPLOVERS LIABILITY <br />V PROPRIETOW PARTNERIE%ECUTIVE .L. EACH ACCIDENT <br /> FFN;EfUMEMBER FSCLUDE09 .L. DISEASE-EA EMPLOYEE <br /> yes, tlescribe mMer <br />PECIAL PROVISIONS below .L. DISEASE-POLICY LIMIT <br />~6 <br /> THER: <br />DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS <br />Wrestling / CA <br />Policy Deductibles: $0.00 per each bodily injury / $500.00 per each property damage claim. <br />See Attached: <br />CERTIFICATE HOLDER CANCELLATION <br />City Of Santa Ana <br />20 Civic Center Plaze <br />Santa Ana, CA 92702 Pf 1"~'1? ~ ~'/ ~: -~ f"~ ~~~ ~Q~Z <br />'lam' ~1 ~ .1>/2_--- <br />Attentlon: -----1~f``... ~.-...::. <br />_. _ °.ltccrcey <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />GATE THEREOF, THE ISSUING INSURER WILL MUIL 30 DAYS WRITTEN NOTICE TO THE '. <br />CERTIFICATE HOLDER NAMED TO THE LEFT . <br />Bob Leid <br />ACORD 25 (2001/08) ©ACORD CORPORATION 1988 <br />