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A '�00Y U 6 9 -v Y3 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE OPID PC DATE(MM/)DIYYYY) <br />BOYS -10 01/15/08 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <br />Chapman & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License #0522024 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. o. Sox 5455 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />Pasadena CA 91117 -0455 <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS <br />Phone: 626 -405 -8031 Fax: 626 - 405 -0585 <br />INSURERS AFFORDING COVERAGE NAIC 0 <br />INSURED <br />INSURERA: Great American <br />POLICY NUMBER <br />DATE MMIFDD/YY) <br />INSURER B: <br />LIMITS <br />Boys & Girls Club of Santa Ana <br />1615 E. 17th Street, Ste. 150 <br />Santa Ana CA 92703 <br />INSURER C: <br />GENERAL <br />INSURER D: <br />INSURER E: <br />rnt>co A r_ rc <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS <br />OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />NS <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MMIFDD/YY) <br />DATE (MMIDDM 1 <br />LIMITS <br />GENERAL <br />LIABILITY <br />EACH OCCURRENCE <br />$1,000,000 <br />A <br />X <br />X <br />COMMERCIAL GENERAL L"LITY <br />CAP8049630 <br />01/01/08 <br />01/01/09 <br />PREMISES (Ee ocurence) <br />$100,000 <br />CLAIMS MADE FX OCCUR <br />MED EXP (Any one person) <br />$5,000 <br />PERSONAL & ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$3,000,000 <br />GENLAGGREGATELIMfr APPLES PER: <br />PRODUCTS - COMPIOPAGG <br />$1,000,000 <br />POLICY PRO - <br />.ECT LOC <br />AUTOMOBILE <br />LIABILITY <br />A <br />X <br />ANY AUTO <br />CAP8049630 <br />01/01/08 <br />01/01/09 <br />COMBINED SINGLE LIMIT <br />(Esacddent) <br />$ 1000000 <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />BODILY <br />erperson) <br />(Per person) <br />$ <br />X <br />HIREDAUTOS <br />X <br />NON- OWNEDAUTOS <br />BODILY IN,AIRY <br />peraccbent) <br />$ <br />PROPERTY DAMAGE <br />$ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANY AUTO <br />OTHER THAN EA <br />$ <br />AUTO ONLY: AGG <br />$ <br />EXCESS/UMBRELLA UABILITY <br />EACH OCCURRENCE <br />$ 5000000 <br />AGGREGATE <br />$5000000 <br />A <br />X OCCUR EICLAIMSMADE <br />MdBS049631 <br />01/01/08 <br />01/01/09 <br />$ <br />0 DEDUCTIBLE <br />$ <br />X RETENTION $10000 <br />$ <br />VYORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />TORYLIMITS I ER <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />If Yes, desa�e under <br />SPECIAL PROVISIONS below <br />E.L DISEASE- POLICY Lrv11T <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS If VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />City of Santa Ana is named additional insured with respect to the <br />operations of the named insured per the attached endorsement. 10 days <br />notice of cancellation for non - payment of premium. <br />SAWXIL3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC <br />DATE THEREOF, THE ISSUING INSURER VNLL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Santa Ana Redevelopment Agency <br />Attn: Frank Hernandez IMPOSE NO OBLIGATION OR LIABILITY OFANY KIND UPON THE INSURER, ITS AGENTS OR <br />P.O. BOX 1988 REPRESENTATIVES. <br />Santa Ana, CA 92702 AUWC91PEDREP _ Nrn j* <br />