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<br />Page 2 of2 <br /> <br />Certificate of Insurance <br />Sparta Program <br /> <br />Name Insured: <br /> <br />Jorgensen, Kent <br />36 Windswept Way <br />Mission Viejo, CA 92692 <br /> <br />Named Additional Insured: <br />SANTA ANA (SPARTA) <br />20 Civic Center Plaza PO Box 1988 <br />Santa Ana CA 92701 <br /> <br />Certificate # <br /> <br />SSA04-0028 <br /> <br /> <br />Carol Frost I President <br />Municipality Insurance Services, Inc. <br /> <br />APPROVED AS TO FORM <br /> <br />~ ~/rl <br /> <br />Laura Stitt Sheedy <br />Assistant City Attorney <br /> <br />302 W. Cerritos Ave Bldg# 7 Anaheim, CA 92805 (800) 420-0555 (714) 687-1100 fax (714) 687-1106 LicensesCA:OC04849; OR: 195423 <br />Website address www.2sparta.com <br />