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RightFax 9/11/2003 7:34 PAGE 2/3 RightFax <br />ACORD_ CERTIFICATE OF LIABILITY INSURANCE Page 1 of Z <br />09/ 1/2003 <br />PRODUCER 877 -559 -6769 <br />THIS CERTIFICATE IS ISSUED AS A- MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Mllis V.-th ADacica, Lac. - A 91=al cs t Center <br />11201 M. Tetm Bl.d. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />suite 300 <br />PheeDi :, AE 85021 <br />INURED Siateca of Bt. Joseph of Oceago <br />IHSMAA: Bactford Co of the Midesat 37478 -001 <br />480 South Batavia <br />Oraiga, D 92868 <br />IN9UIEA8: <br />NBURER C: <br />INSURERD: <br />j <br />INSUIERE: <br />5 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES AGGREGATE LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAIDCLAIMS, <br />ml <br />TYPEOF"IMNCE <br />POLICY NUMBER <br />City Of Santa Ana, its Officers, agents <br />and Employes Cavmunity Development AgeDCT <br />20 Civic Center places <br />POU Y T <br />UMTs <br />No. M25 - P.O. Boa 1980 <br />Attn: Lucy Vlorev <br />aanta Ana, CA 92702 <br />GeNERALUas11J1Y <br />ACCYRD OA'.R T7AYT1 <br />EACHOCCMFIENCE <br />j <br />RREDAMAGE M meta <br />5 <br />HCONAERGAL OENOM DASILTTY <br />CLA819MAOE EJOCCIq <br />MEDEXP w emn <br />j <br />PERSONALSAUVINIURY <br />{ <br />GENERALAGGREOATE <br />j <br />OFNIAGOPEGATELMTAPKESPER: <br />PRODUCTS - COIWDP AGO <br />E <br />P D Loo <br />A <br />011100I1LEUANUTY <br />NNYAUTO <br />�L17MMmHNCLE DMIT <br />1 <br />j, <br />ALLPMEDAURTS <br />BDF®IAEOAUT08 <br />BODILY INJURY <br />(PbpeMn) <br />: <br />HIREDAUT05 <br />MJT08 <br />APPaM <br />ED AS TO <br />FORM <br />BODLV INJURY <br />(Pe'') <br />i <br />lPrRc)pfl:rryIMMAGE <br />i <br />GARIIGEUABILRY <br />AUTOONLY- EAACCDENT <br />E <br />N VAUTO <br />I_R T'2 S <br />dy <br />OTT1Bi THAN EA ACO <br />i <br />= <br />' ci <br />y AtIorpey <br />AUTOOeaV'. AGO <br />MOBBS <br />UAMLDY <br />OCCUR CLA sIVADE <br />EAp1OCCAAiREHM <br />j <br />AOCINIATE <br />E <br />Is <br />i <br />OEULICTItyE <br />RET@AION <br />A <br />waRIGOM nORAND <br />72ME93300 <br />5/31/2003 <br />5/31/200A <br />EL EACH ACCIDENT <br />j <br />EL DISEASE. FA EMPLOYEE <br />S D <br />EL DISEASE -PCUCY LINT E <br />OTHER <br />DEACRRn10N OFOPp1ATIONBILOCATIONRNEMCLEti %CIMWpp ADDED BY MOORS WENUSPEGAL PROYINONB <br />Re: SSJO dba Taller Ban Jove, Slock Grant, BIG N. poinaetta, Santa Ana, CA 92701 <br />CFRTIPRCATE MCI nrR I I <br />...... w11 :812130 Tpl:loalil Us= :J424506 _ CACORDCORPORATION TB88 <br />BHOULO ANYOFTNEASDVE DESCRIBED POUG£t BE CANCELLED BFFORETHE EARRATION <br />WMTTEN <br />MTE THEREOF, THE MBUMIMURER WILL ENDEAVOR TO MA,IaL�a3eGe <br />City Of Santa Ana, its Officers, agents <br />and Employes Cavmunity Development AgeDCT <br />20 Civic Center places <br />�DAR <br />NOTICE TO THE CERnRcxTEHOLDERNAMEDTO THE LI£Te- <br />No. M25 - P.O. Boa 1980 <br />Attn: Lucy Vlorev <br />aanta Ana, CA 92702 <br />AUTHORGEDREPRIS An <br />ACCYRD OA'.R T7AYT1 <br />...... w11 :812130 Tpl:loalil Us= :J424506 _ CACORDCORPORATION TB88 <br />