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<br />--J!tCORD CERTIFICATE OF LIABILITY INSURANCE 1480177 I DATE (MMtDDNYYY) <br />'" 7/09/08 <br />PRODUCER THIS CERTIFICAre IS ISSUED AS A MATreR OF INFORMATION <br />K & K Insurance Group, I.nc. ONLY AND CONFERS NO RIGHTS UPON lHE CERTIFICATE <br />1712 Magnavox Way HOLDER. lHlS CERTIFICATE DOES NOT AMEND. EXTEND OR <br />P.o. Box 233B ALTER lHE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Fort Wayne, In 46801 <br /> INSURERS AFFORDING COVERAGE NAICiI <br />INSURED INSURERA: NATIONWIDE LIFE INSURANCE COMP <br />THE BASS FEDERATION. INC <br />D/B/A TBF, INC. INSURERS; NATIONAL CASUALTY COMPANY <br />AND ITS MEMBER STATE FEDERATIONS lNSURERC: <br />2300 COLEMAN ROAD INSURERD: <br />PONCA CIty, OK 74604 INSURER E: <br /> <br />NLS <br /> <br />lHE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITliSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIRCATE MAV BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL\.. THE 1ERMS. EXCLUSIONS AND CONCmONS OF SUCH <br />POlICIES. AGGREGATEUMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DO' POLICY NUIIBER POUCY EfFECT~ POllCYEXPtAATION <br /> UMlTS <br /> ~ERAL UABLIlY 12~01AM 12: OlJl..M ~ S 1000000 <br />B l rlMERCIALGENERAL UABLITY KKOOOOO247500 1/27/08 1/27/09 P E S <br /> ClAIMS MACE ~ OCCUR MEDEXP....,""',.....,) , 'OM <br /> - Owners & Contractors PERSONAL IlADY INJURY $ 1000000 <br /> - GENERAL AGGREGATE S NONE <br /> ~LAG~rlEL'W~N'n~ PRODUCTS~COMPIOPAGG S 1000000 <br /> POLICY ~ LOG /Part Ln'l Liab I. 1000000 <br /> l.!.UTOMOBU LIAlWTY ccqlNEDSIHGLEUMtT S <br /> m1 AUTO (Ea_ <br /> l- <br /> f- AlLOWNEDAUTOS BODLY1NJURY <br /> SCHEDULED AUTOS (PerpetSOl'll S <br /> f- <br /> ~ HIRED AUTOS BODLYINJURY $ <br /> H NO~WNEDAUTOS (Pefeoeldent) <br /> - - <br /> PROPERTY DAMAGE <br /> I fPO<""",",1 . <br /> RGEUMILIfY AUTO ONLY _EAACCIDENT , <br /> _AUTO OTHER THAN EAACe , <br /> AUTO ONLY: AGG S <br /> :=JCESSAJMBRELLAUABIU'CY EACH OCCURRENCE . <br /> OCCUR 0 ClAINSMAOE '..' r. ,'ORM AGGREG/>'" . <br /> . <br /> ~ DEOUCT1flLE 1/ ) ,/ S <br /> RETENTJQtl . , I S <br /> WORKERS COMPENSATION AND 'YYAM-{, './-+-- I T~"TA-W-~ I Iogi- <br /> _-1-0/ -.:" . 1 OJ.MI <br /> EMPLOYERS' UABlUTV j <br /> ANY PROPRlETOfWARlNERJEXECl1TM:. ,._ ~i~i,~ EL EACH ACCIDENT , <br /> OfFlCERtMErolBER EXClUDED? .ji . ....) <br /> t'. 'I'..... "f.... E.L.DISEASE-EABiA.OYEE S <br /> ~i?:~~~Sbeklw '>.>1....' J <br /> E.L. DlSEASE. POLICY UMtT , <br /> OTHER 12: ClAM I 12:01AM IAD&D NONE <br />A Participant Accident SPXOOO3283BOO 1/27/08 1/27/09 Primary Medical NONE <br /> Excess Medical NONE <br /> I week!;:' Indemnitv x NONE <br />DESCRPTICN OF OPERAl1ONS 1 L.QCATlONS IvatlCLESI EXCWSIONS ADDeD BYENDORSEMENT I SPEClALPROVIStoNS <br />EVENT , PATHWAYS TO ADVENTURE BASSERS/ADVENTURE DAY DATES: 7/1-8/30/08 <br />LOC: OAK CANYON PARK & CENTENNIAL PARK, CA CERT. HOLDER IS NAMED ADDITIONAL <br />INSURED AS RESPEcrS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. <br /> <br />COVERAGES <br /> <br />CITY OF SANTA ANA, ITS OFFICERS, <br />EMPLOYEES, AGENTS r VOLUNTEERS AND <br />REPRESENTATIVES <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />T V 77 <br />ACORD Z5 (ZOOlI08) <br /> <br />CANCELLATION <br />SHOULD AHY OF THE ABOVE DESCRIBED POLICIES BE GANCEL1.ED...REFORf THE EXPIRA noN <br />DATE THEREOf, THE iSSUING INSURER wu..L. ENDEAVOR TO MAl.. 30 DAYS WRITTEN <br />NOTICE TO THE ceRTtFtcATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAl.L. <br />IMPOBE NO OBLIliATtoN OR UAB/UIY OF Nf'( KIND UPON THE <br />REPRESEHTATtVE <br />AUTHORIZED REfIRES <br /> <br /> <br />ON 198B <br /> <br />CERTIFICATE HOLDER <br />