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32082 ACORO® CERTIFICATE OF LIABILITY INSURANCE DAT 0 2 If ? 1 1/26/2012 1/26/2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Andrea Wright- Wells Fargo Insurance NAME Commercial Lines - (719) 592-1177 PHONE 800-332-9256 FAX 877 405 0932 - - AC No: Wells Fargo Insurance Services USA, Inc. wn andrea hl@wellsfar o oom AD g . g . DRESS. 5755 Mark Dabling Blvd., Suite 300 INSURERS AFFORDING COVERAGE NAIC # Colorado Springs, CO 80919-2228 INSURERA i Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B' National Archery Association dba USA Archery INSURER C : 711 N. Tejon Street N INSURER D: s t?j 'a ?/c INSURER E: Colorado Springs CO 80903 INSURER F : COVERAGES CERTIFICATE NUMBER: 3862498 REVISION NIIMRFR- Q.. Lot,.,., THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR R TYPE OF INSURANCE AD L UBR POLICY NUMBER MMI OYEFF MMIDDffYY LIMITS A GENERAL LIABILITY pHPK814663 1/15/2012 1/15/2013 EACHOCCURRENCE $ 1000000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100000 F?17 CLAIMS-MADE OCCUR MEO EXP(Any one person) S EXd PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE S 3000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG S 3000000 POLICY X PRO LOG lPr.T F7 S AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E. accident ANY AUTO BODILY INJURY (Par person) S ALL OWNED AUTOS SCHEDULED AUTOS .t F%.9 3? `? ty/)•?1? ) - jC?1??L BODILY INJURY (Per eCpitlanl) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccidant $ $ UMBRELLA LIAR H OCCUR _ r. - - EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE J_,HI]Id `,( AGGREGATE ' $ v IIV '"?lr L n?.;'C' DED RETENTIONS . 151fla g `-[ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY 3 YIN ANY PROPRIETOR/PARTNENEXECUTIVE 7-7 OFFICERM M NIA E.L. EACH ACCIDENT S -' - E BEREXCLUDED? (Mandator, In NH) E .L. DISEASE- EA EMPLOYE $ t If yes, deecnbe under DESCRIPTION OF OPERATIONS MI. E. L. DISEASE - POLICY LIMIT $ " r_ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AHach ACORD 101, Additional Remarks Schedule, if more apace is mquimd) - Named Insured Includes Santa Fe Trail Archers The certificate holder is only an additional insured with respect to liability caused by the negligence of the Named Insured as per Philadelphia Indemnity form PI-AM-002 Additional Insured-Certifcate holders Coverage applies to the above with respect to sanctioned events, club practices, club fundraisers and meetings City of Santa Ana, its officers, agents, employees, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and volunteers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Parks, RED, 8 Community Services Agency 20 Civic Center Drive AUTHORIZED REPRESENTATIVE Santa Ana, CA 92703 ge-441, The ACORD name and logo are registered marks of ACORD @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)