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<br />From: Sandi WFredericksen At: Wood-Gutmann Insurance Brokers FaxlD: 714-573-1772 To: Laura/City of Santa Ana
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<br />Date: 3/1512005 11 :00 AM Page: 2 of 5
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<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE CSR SF I DATE (MMIDDNYYY)
<br />CATHL-1 03/15/05
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Wood-Gutmann Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />License #0679263 HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
<br />14192 Franklin Ave., Suite 200 ALTER THE COVERAGE AFFORDEO BY THE POLICIES BELOW.
<br />Tustin CA 92780-7044
<br />Phone:714-505-7000 Fax: 714-573-1770 INSURERS AFFORDING COVERAGE NAIC#
<br /> ~. ----.--.----- I -~ ------
<br />INSURED ¡J. ;)N,Lj.{qS'OI ~~::;Uf\eRP., Zurich US 19305
<br /> ----.---.-
<br /> -.----.---
<br /> N::;URER8
<br /> Cathleen Forcucci Dance INSUREPC
<br /> Acad~, Fullerton C-----'
<br /> 3040 ry st INSUR;:::¡D
<br /> Riverside CA 92506
<br /> INSURER E
<br />
<br />COVERAGES
<br />
<br />THI:: f-'()_(~If::'", ()~ l'bURA~CE LISTED BELOW HAVE:. BeeN 1::;::;UtD ¡O THE INSURED t,J.AMED ABOVE <\R 'He POLICY PERIOD INDICA~ED NOTWITHSTA~OING
<br />ANY =1EOUIREMENT, TERM OR CONDIT ON (FANY cmHRACT OR OTHER DOCUME~JT \i\hTH RESP!::CTTO VVHICH THIS CERTIFICA'E f./AY BE ISSUED OR
<br />MAv PERTAIN, THe-: I'JSURANCE AFfORDED BY THE POLICIES DESCRIBED HERE I!\; IS SUBJECTTC ALL THE TEf;'MS, "XCLUSIOI\':::, A.ND cor~DITICNS OF SUCH
<br />f-\)LICll'~ !\GGFEC'ATE LIM'TS SH()W~J MAY HAVl LJLLI\ REDUCED BY PAiD CLAIM::;
<br /> ~ ~-- ----- I "DATE (MMíDD~ P~TE' (MMIDDNY)
<br />LTR "SR TYPE OF INSURANCE POLICY NUMBER LIMITS
<br /> ,.?~NERAL LIABILITY ! EACH OCCURREI\ICE. ! $ 1,000,000
<br />A ~. ÕMERCIAL GtNtKAL LiAbiLITY 042823782 12/04/04 12/04/05 PREMIS-S,:EaoccLrSrlCs) I, *1,000,000
<br /> - - '~l /\IMS MAnF ~ or:cu< I MFD ¡::XP ¡Any Or18 ppr;on) ' 10,000
<br /> ~ *Tenant Leq1 Liab P"PSONAI fi. MV IN,1l :PY $1,000/000
<br /> GENERAL AGGREGATE' $2,000/000
<br /> -
<br /> GEN'L AGGREGATE LIMIT AFf'LlES PER mODUCE - COMF'IOF' AGe, $2,000,000
<br /> I POLn n ~t2T n LOC
<br /> ~TOMOBILE LIABILITY COMl:JlNtU SINGLE LlMl $ 1/000,000
<br />A A.NY AUTO 042823782 12/04/04 12/04/05 (ea aCCljent)
<br /> -. -.
<br /> - ALL OWNtC AUTO:'; I:J~UILY INJURY
<br /> ,
<br /> SCt--EúULi::D AUf OS (Per person ~
<br /> ~
<br /> ~ '1IREDAUTOS ROOII.Y INJURY
<br /> $
<br /> ~ "JON-OWNED AUTO:=; (PAr 8cçirje~t)
<br /> - PROP':PTY DAMÞ,GE ¡
<br /> (Per aCCident)
<br /> ~AGE LIABILITY AUT8 or~L Y - EAACCOENT $
<br /> ,£l.NYAUTO OTHER IHA'J EAACC $
<br /> AUTO ONLY AGG $
<br /> ÒESSIUMBRELLA LIABILITY [AClI OCCuRRENCE $
<br /> - OCCUf-i n CLAIMS MA,Ue FORIv ' ",GGRE GA ~E $
<br /> ¡'RÜV ED AS TO , $
<br /> "
<br /> R )EOUCTIBLE '/4 $
<br /> RETENTION $ ~ If;) ~,..¡f $
<br /> WORKERS COMPENSATION AND /,' '-. ,~, !T~~~;~1is! !°i:¡
<br /> EMPLOYERS' LIABILITY d ~ I ,,1l1ia ~~i,ShèCdY
<br /> NN PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ftCCIDENT $
<br /> 1""\ tv AttnrnCy
<br /> :JFFIC':FRIMFMBER EXCLUDED? ''¡",,-.-'' [L DISEASE - EA EMPLOYEE i $
<br /> Ifypc"d",cribeulldor E.L L)ISeAGE, POLICY LIMIT I $
<br /> SPECIAl PROVISIONS bclol'v
<br /> OTHER
<br /> I ,
<br />DESCRIPTlON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />*10 Days for Non-Payment of Premium. City of Santa Ana and their respective
<br />officers, employees, agents, volunteers and representatives are named as an
<br />additional insured per attached endorsement #CG20261185. Waiver of
<br />Subrogation also applies per attached endorsement #CG24041093
<br />
<br />CERTIFICATE HOLDER
<br />
<br />SANTA07
<br />
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />
<br />*30
<br />
<br />DAYS WRmEN
<br />
<br />City of Santa Ana
<br />peggy Calvert
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
<br />IMPOSE NO OBLIGATION OR LIABILITY Of ANY KIND UPON THE INSURER. ITS AGENTS OR
<br />
<br />ACORD 25 (2001/08)
<br />
<br />
<br />u-R,¡{"
<br />
<br />
<br />RPORATION 1988
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