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32082 <br />ACC>27 CERTIFICATE OF LIABILITY INSURANCE <br /> <br />I oAT <br />(MM <br />rr1 <br /> <br />*1I 3/ <br />19/2013 <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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 CAMONTACTE Andrea Wright - Wells Fargo Insurance <br />: <br />Commercial Lines - (719) 592-1177 P <br />HCNE <br />800332-9256 AX <br />877-405-0932 <br /> A <br />Ne <br />Exh. <br />Wells Fargo Insurance Services USA, Inc. E-MAIL <br />ADDRESS: andrea.wri9htGmwellsfar9o.coln <br />5755 Mark Dabling Blvd., Suite 300 INSURERS AFFORDING COVERAGE NAIC # <br />Colorado Springs, CO 80919-2228 INSURERA: Philadelphia Indemnity Insurance Company 18058 <br />INSURED <br />INSURER B <br />National Archery Association dba USA Archery <br /> INSURER C <br />4065 Sinton Road <br /> <br /> INSURER E: <br />Colorado Springs CO 80907 INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 5754715 REVISION NUMBER: See heloW <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 />INSR ADDL SUBR POLICY I <br />LTR TYPE OF INSURANCE ISS <br />M WVD POLICY NUMBER MM <br />IDDIYYYY LIMITS <br />A GENERAL LIABILITY PHPK966205 1/15/2013 1/15/2014 EACH OCCURRENCE $ 1000000 <br /> DAMAGE TOR NTED <br /> COMMERCIAL GENERAL LIABILITY E SE$ Es occurrence $ 100000 <br /> CLAIMS-MADE E OCCUR MED EXP Any one person $ Excl <br /> PERSONAL it ADV INJURY $ 1000000 <br /> GENERAL AGGREGATE $ 3000000 <br /> GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 3000000 <br /> POLICY X PRO LOC $ <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ee accident <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED <br />BODILY INJURY (Per accident) <br />$ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Pan accident <br /> <br />A UMBRELLA LIAB X OCCUR PHUB408260 1/15/2013 1/15/2014 EACH OCCURRENCE $ 2000000 <br /> X EXCESS LIAB CLAIM&MADE AGGREGATE $ 2000000 <br /> ?ED RETENTION $ <br /> WORKERS COMPENSATION WC STATU- D <br />TY_ <br /> AND EMPLOYERS' LIABILITY DRY L T <br />IR <br /> YIN <br /> ANY PROPRIETORIPARTNERIEXECUTIVE? NIA E.L. EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandate, in NH) E.L. DISEASE- EA EMPLOYEE $ <br /> If yes, describe under <br /> DE SCRPTION OF OPERATIONS Ii E.L. DISEASE-POLICY LIMIT $ <br /> <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />Named Insured Includes Santa He Trail Archers <br />The City of Santa Ana, its officers, agents, employees, and volunteers, Parks, Recreation, and Community Services Agency are only an additional insured <br />with respect to liability caused by the negligence of the Named Insured as per Philadelphia Indemnity form PI-AM-002 Additional Insured-Certificate holders <br />Coverage applies to the above with respect to sanctioned events, Club practices, club fundraisers and meetings <br />This insurance is primary and non-contributory. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, Parks, Recreation, & SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Community Service Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE <br />The ACORD name and logo are registered marks of ACORD © 1988.2010 A.PiC F / ! VffT40N. vAlWtg dSVr? Ved. <br />ACORD 25 (2010105) VV ..GG IIJJ 1t'SSne77 1 W 0.J <br />LISA E. STORCK <br />Assistant City Attorney