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�y received ,4coRo® CERTIFICATE OF LIABILITY INSURANCEDATE (MM/1 ) 7/5/2012 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltions of the Policy, certain Policles may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER C6 A Spor -a NAM V@RY)rOOk =nS _ S02Vi Cab PHONE FAX N = CA License OD80832 E-MAIL ADOR 6320 Canoga Ave . 12th Flr. . INSURERS AFFORDING COVERAGE MAIC 9 Woodland Hi11s CA 91367 --- INSURED Angalika M. Nemeth 19 Ash Tref= Lane ' =rVi RO CA 92612 fNSURIE. F- rwconr_cc 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. IN R TYPE OF INSURANCE POLICY EFF POLICY EXP IT. POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ X' 000, 000 X —O IER,-AL GENERAL LIABILITY AAM RENTE A CLAIMS -MADE F- OCCUR 1M3M141791 /28/2012 /20/2013 PR E.I $ 100,000 MEO ExP (An one per•..on) $ 2,500 X Pror...S oL al PERSONALE ADV INJURY $ 1,000,000 X Liability GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3, 00 O , 000 X POLICY ,-- O LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI ANY AUTO BODILY INJURY (Per person) $ ALLOWNED fJ SCHEDULED AUTOAUTOS BODILY INJURY (per aent)S NONOWNED _ PROPERTY DAMAGE F $ HIRED AUTOS AUTOS .A i. ` :�.� (.„/ �,� L Z% AS a 1�, 1 A IJO-i $ UMBRELLA LMB OCCUR /�/% EACH OCCURRENCE $ EXCESS LIAB G AGGREGATE $ _ O -D RETENTION$ ---' $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'-ABILITY YIN �..:ll St ")i. City A to,--- ANYJ . PROPRIETO R/ PARTNER/F>(EGUTIVE O—CER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ (MarWalory In NH) E.L DISEASE - EA EMPLOYE $ m, desuihe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Ramarlt5 Schedule, If mora space Is r -,—Id) +'30 Day Notica o£ Cancellation £or Non -Payment o£ Premium C@rti£icata Holder is hereby addrad as a Hamad insured member oP the Fi=—a and Wallness Purchasing Group_ Certi£ioatra Hold@r is Hamad as Additional insured as respects Gfanal Liability as per policy Forms and conditions. City of Santa Ana Parks, Recreation and Community S---Laas Agency Donna Schultze 1825 W_ Cl -:L- Canter Santa Ana, CA 92701 (Susan Patton/MDP © 1988-2010 ACORD CORPORATION. All rights reserve, Thu Af -nl n ern finni-- -- r Ar' -n=” ACORD 25 (2010/05) I NSD25 nm msi n I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE