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32082 <br />ffi14. � �,G�+ CERTIFICATE ®F LIABILITY INSURANCE <br />oAT3l19/2013 <br />PE OF INSURANCE <br />3I19I2013 <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(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 andorsement(s), <br />PRODUCER <br />CONTACT Andrea N/right- Wells Fargo Insurance <br />Commercial Lines -(719)592.11%7 <br />PHONEg00.332-9255AX <br />: IA¢ Ne, 877405.0932 <br />No Bet)ndrea.wri <br />Wells Fargo Insurance Services USA, Inc. <br />Tm _ <br />EMAIL ht�'a)w <br />AODd,F,39__a--,-__9 - elisfargo.com__ <br />5755 Mark Dabling Blvd.,Suite 300 <br />^_ INSURERCu AFFORDING COVERAGE <br />NAICa <br />Colorado Springs, 00 80919-2228 <br />INSURER A: Philadelphia Indemnity Insurance Company <br />18058 <br />INSURED <br />_ <br />INSURER 9: <br />National Archery Association dba USA Archery <br />GENERAL AGGREGATE S 3000000 <br />4085 Sinton Road <br />INSURER C <br />--`--T"'^"' <br />INSURER D ; <br />LIMIT APPLIES PER: <br />X PRO' LOU <br />Colorado Springs CO 80907 <br />INSURER E: <br />---- INSNRER F: <br />..._.__---------- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VEJFOR 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 />UTR <br />PE OF INSURANCE <br />BUD <br />POLICY NUMBER <br />POIJCY EFF <br />MI DI1'Y <br />POUCV EXP <br />IYYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MAGE OCCUR <br />PHPK965205 <br />1115!2013 <br />1115/2014 <br />__ <br />EacH occuaRENCE s _ tasoeCo <br />CAMP, 9 Ea oc u r S 100000 <br />MED EXP Any ane amour)) S <br />_Excl <br />PERSONAL INJURY $ Y�1000000 <br />GENERAL AGGREGATE S 3000000 <br />GEN'L AGGREGATE <br />POLICY <br />LIMIT APPLIES PER: <br />X PRO' LOU <br />PRODUCTS AGO S 9000000 <br />S <br />AUTOMOBILE <br />LIABILITY <br />tEgM INEDI SINGLE LIMIT <br />BODILY INJURY (Per person) S <br />ANY AUTO <br />ALL OWNED. SCHEDULED <br />AUTOS AUTOS <br />I <br />BODILY INJURY Peraccidenl $ <br />( ) <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE <br />P real S <br />f e tlentt <br />9 <br />A <br />UMBRELLA LIAR <br />X <br />OCCUR <br />PHUS408260 <br />1/15/2013 <br />1(15(2014 I <br />EACHOCCURRENCE $ 2000000 <br />X EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE $ 2000000 <br />IDED I RETENTIONS <br />$ <br />1 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECOTIVE <br />OFFICEWMENISER EXCLUDEDT ❑ <br />NIA <br />WC eTATU- OTW <br />-MRYLIMI ,. <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYED S <br />(Mandatory In NH) <br />Dyaa, describe OF O <br />ECRI TIONOFOPERATIONebolow <br />E.L. DISEASE - POLIGYLIMIT S <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ADORE 101, Additional Remarks Schedule, if more space is required) <br />Named Insured includesBanta Fe11 - 17raU 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 4o the above with respect to sanctioned events, club practices, club fundraisers and meetings <br />This insurance is primary and non-contributory. <br />City of Santa Ana, Parks, Recreation, & SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Community SeNce Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, GA 92703 AUTHORIZED REPRESENTATIVEI / <br />l("" <br />n <br />The ACORD name and logo are registered marks Of ACORD ©1988.2010 ACRRA.ARAT}N, rhtivigJfLs4��y6 <br />ACORD 25 (2010105) <br />LIbA G. J 1 t.JttGry p� <br />Assistant City Alterney S <br />