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- Z�d7- oY� -�� <br />�'� � °® CERTIFICATE OF LIABILITY INSURANCE <br />ei9�2oi�Y' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),. AUTHORIZED <br />REPRESENTATIVE OR PRODUCER,. AND THE CERTIFICATE HOLDER. <br />IMPORTANT: H the certificate holder is an ADDITIONAL INSURED, the policy(ias) must be endorsed. H SUBROGATION IS WAIVED, subject to <br />the farms antl conditions of the policy, certain policies may require an endorsamanL A statement on this certiflcata does not confer rights to the <br />certificate holder in Ileu of such ¢�dorsement(s). <br />PRODUCER <br />TI'10 Allen J Flood COmp3Y118B =nC <br />Two Madison Avenue <br />Larcllmont NY 10538 <br />CONTACT L811r8 S ®lby <br />PNONE (914)834 -9326 FAC No- (910834 -9330 <br />-""AIL _laelby @ajt'usa. com <br />INSURE S AFFORDING COVERAGE <br />NAIC # <br />INSURERA p}11Z ad91 1'113 =n911raInCe CO <br />UMITS <br />INSURED <br />Tile California Youth Spirit 6 Twirling Corps <br />22755 Mesa Springs Way <br />Moreno Valle CA 92557 <br />INSURER B :IIS Fire Sns_urance Com n <br />INSURERC: <br />wsuRER D: <br />INSURER E <br />$ 1 , 000 , 000 <br />INSURER F <br />$ 100 , 000 <br />COVERAGES CERTIFICATE NUMBER_2011 -2012 Add � 1 insured REVISION NUMBER• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND)TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SV BJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TYPE OF INSURANCE <br />20 Civic Canter Plaza <br />POLICY NUMBER <br />POUCY EFF <br />MM/D <br />POLICY EXP <br />UMITS <br />GENERAL LMBILITY <br />EACH OCCURRENCE <br />$ 1 , 000 , 000 <br />p MI o rte <br />$ 100 , 000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIM SMADE � OCCUR <br />X <br />HPK- )56938 <br />/1/2011 <br />/1/2012 <br />MED EXP An one rson <br />E O <br />PERSONAL B ADV INJURY <br />S 1 , OOO , OOO <br />GENERAL AGGREGATE <br />$ 3 , 000 , OOO <br />GEN'L AGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />E 3 , OOO , 000 <br />S <br />X POLICY <br />PRO LOC <br />AUTOMOBILE <br />LW 6IUTY <br />COMBINED SINGLE LIMIT <br />atidera <br />BODILY INJURY (Per pereon) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Par accitlalrt) <br />$ <br />HIRED AUTOS gNOU'fQSWNED <br />Pel acE<RM�IDAMAGE <br />E <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />S <br />EXCESS LUIB <br />CLAIMS -MADE <br />OED RETENTION$ <br />$ <br />WORKERS COMPENSATON <br />VYC STATU- OTH- <br />AND EMPLOYERS' UA9ILITY Y / N <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />OFFIGER/MEMBER EXCLUDEDT � <br />N / A <br />EL EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />E <br />(MaIMHOry In NNl <br />f yyB9. CBafllb6 Undal <br />DESCRIPTON OF OPERATONS balwv <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />Matllral Max umu $ 2 5 , 0 00 <br />B <br />ACCTdant /M @di Cal <br />G1B11A <br />/1/2011 <br />/1/2012 <br />paaucubla $O <br />DESCRIPTION OF OPERATIONS / LOCATONS l VEMCLES (A[o <h ACORD 101, AtlaMOnal Ramarluc Schatlule. H mots space la requiLM) <br />Corti Ficate holder is Hamad as additional insured <br />R.� „I4t A': �_ l�ilY /S LLU rn CY <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (201 O /OS) ®1988 -2010 ACORD CORPORATION. All rights reserved. <br />INSD25 r9IM rNL51 m T6a, ARf1RD name snA Inner ar,n �sn:¢M.oH mar4c �r Ar:TlRrl <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATON DATE THEREOF, NOTCE WILL BE DELIVERED IN <br />CSty o£ $iota Ana <br />ACCORDANCE WITH THE POLICY PROVL410N3. <br />20 Civic Canter Plaza <br />AVTNORIZED REPRESENTATNE <br />�Janta Ana, �• -A 9•Z •i01 <br />Fl ialcer /LSES.HY ��� <br />ACORD 25 (201 O /OS) ®1988 -2010 ACORD CORPORATION. All rights reserved. <br />INSD25 r9IM rNL51 m T6a, ARf1RD name snA Inner ar,n �sn:¢M.oH mar4c �r Ar:TlRrl <br />