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'°`�� ° CERTIFICATE OF LIABILITY INSURANCE <br />° "'�`M"" ° °'Y"„„' <br />9/26/2012 <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 INSU RER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement s). <br />PRODUCER <br />Tha A11an J Flood Companies Snc <br />Two Madison Avanua <br />N /��O � —O �� BOOS <br />Larchmont NiY 10538 <br />CONTACT Laura Selby <br />PRONE (914) 922 -9223 FAX (gl<)922 -9210 <br />E -MAIL .1salby @aj£usa.com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA:Ph11 ad01 hie insurance Co <br />INSURED <br />Tha Ca1i£ornia Youth Spirit 6 Twirling Corps <br />22755 Mesa Springs Way <br />Moreno VallEi CA 92557 <br />INSURER B :US Fira Snsurance Com an <br />INSURERC: <br />EACH OCCURRENCE <br />INSURER D: <br />A <br />INSURER E <br />][ <br />INSURER F: <br />HPKB 97643 <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 CONDITION 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 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IN9R <br />T <br />TYPE OF INSURANCE <br />POLICY N MBER <br />POLICY EFF <br />POLICY EXP <br />LIMIT$ <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1 ,QQQ ,QQQ <br />A <br />x COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />][ <br />HPKB 97643 <br />/1/2012 <br />/1/2013 <br />$ 1QQ QQQ <br />MED EXP (Any one person) <br />$ Q <br />PERSONAL &ADV INJURY <br />$ 1,000,QOQ <br />GENERAL AGGREGATE <br />$ 3,000, QQQ <br />GEN'L AGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$ 3 ,QQQ ,QQQ <br />x POLICY <br />PRO- LOC <br />$ <br />AUTOMOBILE LIABILITY <br />MBINED IN LE LIMI <br />a accitlent <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY Per accitlenp <br />$ <br />HIRED AUTOS NON -0WNED <br />AUTOS <br />PROPERTY DAMAGE <br />$ <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED RETENTION $ <br />g <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />AND EMPLOYERS' LIABILITY Y / N <br />ANV PROPRIETOR/PARTNER /EXECUTIVE <br />OFFICER /MEMBER E%CLUDED? � <br />N / A <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory In NH) <br />I! yea, tlasrnbe untler <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />Medical Max Limit 5' 2 rj , Q Q Q <br />B <br />Accident /Medical <br />G1B11A <br />/1/2012 <br />/1/2013 <br />Datluctible rS` Q <br />DESCRIPTION OF OPERATONS / LOCATONS /VEHICLES (Attach ACORD 101, AtldKlonal Ramarha Schedule, M more apace la required) <br />Certificate holder, it's officers, agents and employees era Hamad as additional insuraCL.iit g`�� to <br />General Liability par attached CG 2015 �1V <br />APPROVED �' <br />TORCK <br />L \SA E• S Attorney <br />istant C�tY <br />�r<, Irt�.h t c rrvr_a�crc GANGCLLA I IVN - <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City O£ Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Purchasing Department AUTHORIZED REPRESENTATVE ' <br />20 Civic Cantor Plaza <br />Santa Ana, CA 92701 <br />W Flintier /LSELBY ��� <br />ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION_ All rio htc rwsarvad_ <br />INS025 nm nnsl m The Ar"('1RA Hama and Inrrn aru ranictararl mar4c of AC(-1R Il <br />