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\ ACORD. CERTIFICATE OF LIABILITY INSURANCE I.) -;;)CD'f -b3 i- II - c9C:b4- 63+-01 OP ID 1 BRODE-3 09 28 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 05 PRODUCER Hylant Group - Toledo 811 Madison Ave Toledo OH 43624 Phone: 419-255-1020 Fax:419-255-7557 INSURERS AFFORDING COVERAGE INSURED Jay Broderick dba Mad Science of W,st Orange County 1.2 W~ntermist. Irvine CA 92614 INSURER A INSURER B INSURER C' INSURER 0 INSURER E COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE SEEN 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 P:)LlCIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS SRlA01J'I:J l TR IINSRD TYPE OF INSURANCE .. GENERAL LIABIUTY X !-x---~ COMMERCIAL GENERAL liABILITY PHPK097701. k....m.-'__._. , i : CLAIMS MADE X OCCUR ~x!AbUse/Molestation PHPK097701 1"-G~l'~~A;G~E-~;-~:-LI:I~'~::-L'I:~';E~~: r - 1 POLICY ~~8T AUTOMOBILE LIABILITY .1 ANY AUTO : ALL OWNED AUTOS 'I SCHEDULED AUTOS I : X ; HIRED AUTOS r~1 NON OWNED AUTOS :- ',-- ,. -- ----~ POLICY NUMBER --l "PD~\~YJ~JJ'JW~Rltt~y ~b~iO'f~'T LIMITS 10/15/04 10/15/05 ~ ;~;;gi~g,:~~...---- _-_.l..~s...,..13""'..0'.._OO" O,.---.00...-.0,...-90..-Q_g................. ~:'~?M!;S,!=:,S.{"'lJ,lJc~lJr~~c~) .. _ "_ . _.. ..____ '. ~-~~~,,~:~-(""~X-~~-~__pers:-:':) __ i~_ * 5, 000 ; PERSONAL & ADV INJURy _.1 s -i"': 00 a"', 000 ; GENERAL AGGREGATE ! $2':-0-00';'00-0--- riRO~UC~;; co",P;OP;OG1'~~~; ~~ ~JlO. I COMBINED SINGLE LIMIT S 1, 000 , 000 iEaaccldenl) 1-- + j BODll Y INJURY i s ! (Per person) I s f :$ 10/15/04 10/15/05 PHPK097701 10/15/04 10/15/05 I BODilY INJURY : (Per~C~i~enl},.____ I;;~P~R;~ ~;MAGE-- I (Peraccldenl) EXCESS/UMBRELLA UABILITY OCCUR [__on: CLAIMS MADE l~.U~T_O__~~l. Y - EA _~C~_I?~J>J_T _~~_ .1: OTHER THAN _~~,~_~ I s_ AUTO ONLY: AGG t s : EACH OCCURRF\lCE , AGGREGATE GARAGE LIABILITY r---l ANY AUTO DEDUCTII3L[ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER ! I ~ ,,,- i___jIQB'(_~I,MI"1."_sJ : _ EJ3 --'-____ i EL EACH ACCIDENT '~ IE"'L_-DISEASE:"""E-A-E~;P-L~-;EE: S-- !~:-L:C;;SE.~S-E~~O~ICY-LI~IT'1 $ --- , .-1 '- /127 . --" ~-{-' --.--- .-- -1-.-'--. ../: ',', ,., (\"jj::>W;J] C'll Y DESCRIPTION OF OPERATIONS {lOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Medical Payments excludes Participants. City of Santa Ana Parks, Recreation, & Community Services Agency, its officers, agents, employees, representatives and volunteers are included as an Additional Insured ATIMA. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Parks, ATtn. Dolores Ramos 888 W Santa Ana Blvd., STe 200 P.O. Box 1988 M-23 Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORI D REPRESENT ATIJlE @ACORD ORPORATION 1988 ACORD 25(2001108)