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<br />From: Mary Severson At: Murria & FricK Insurance To: Pearl Reya <br /> <br />Fan: (858) 259.6069 Date: 117/02 01:32 PM Page 2 of 2 <br /> <br />ACQRQ. <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />OPIO )fS I <br />0377819 01/07/02 <br />--T-THIS CERTIFICATE -IS-isSUED AS,,-NiA TfEifOF' ii'I"FOtlMATION - - <br />I ONLY AND CONFERS NO RIGHTS UFON THE CERTJFJCATE <br />HOLDER. THIS CERTIFICATE OOES NOT AMEND. EXTEND OR <br />I ALTER THE COVERAGE AfFORDED BY THE POLICIES BELOW. <br /> <br />DATE (MMlDD/YYl <br /> <br />PROOUCER <br />F~tness & We11ness Insurance <br />Agency <br />380 Stevens Ave., F~rst Floor <br />'Solana Beach CA 92075 <br />I_~hone: 800-395-8075 Fax: 858-519-0822 <br />INSUREO <br /> <br />I <br />1 <br /> <br />I <br />u__! <br /> <br />!NSURERS AFFORDING COVERAGE <br /> <br />Peter Mangosing #0377819 <br />Eff, 8/1/01 <br />2049 So. Pacific Ave_ <br />Santa Ana CA 92704 <br /> <br />1~ISUf'!ER~__ <br />~JSIJ~,E~_=----_ <br /> <br />IrJSURERA. <br /> <br />Specialty National Insurance <br /> <br />-- <br /> <br />[USURER:) <br /> <br />COVERAGES <br /> <br />.i:NS'..'~E~~ <br /> <br />THE POL/CIESOF INSURANCE Lr$TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOABO\lE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAy PE~TAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TOAll THE TERMS, EXCLUSIONS AND CONDnlONS OF SUCH <br />POLICIEs A.GGREGATE LlMliS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> <br />--I POLICy NUMBER I ~~~~C'Y~EFF~7yTfi" - I P::4~\.~:,:~~~J~ON -r-- <br /> <br />I~:; <br /> <br />'!'YPEOFIN~'-'''-&-''lce <br /> <br />GFNEIIt&llf49IlfTY <br />A X i (;OMMEPCIAL CE'JE:.o..... (;AB!L1rv <br />r----r-: CJ\!~S PMOF I X , OCCJ"l <br />A Ix!~sc profes~nal <br />r-- <br /> <br />LIMIT'!! <br /> <br />3%:Z-126451-00 <br /> <br />08/01/01 <br /> <br />08/01/02 <br /> <br />'FArH'l<"IIP""'"C" _' ~ ~iO()O~OO__~ <br />I f-lf.!EDAMAGE:!!'r:yonE~re) r;-100; 000 <br />MED E>o.P (My ""B pBr<;{I~) $ 2 : 500 <br />"fP~()~L&Ar1VllJjURY 1.1,000,000 <br />I (;fN",PALAGGR",GATE i $ 3,000,000 <br />r-::---._--~-t-..----. <br />rROOUC]o;.cC>,1P'O"'~' ~ 1, OO!)_, 000_ <br />, <br /> <br />r~'L AG~f,>tGA-'-~~M~: APPI :~s~- <br />n .~~L;CY r- - ~~27 r ,cc <br />EOMOBILELIAIIlLITY <br />l. .J "'-,"YAUTO <br />,l-J ,ioU O'y'.t'LDAIJTOS <br />WSCcTf:)'-'~E[)AU;oS <br />, .- ~jIREDAU70S <br /> <br />C:--OM"i,NE'D'a.;GLCLI[.<,T <br />(E~ ~r.CJellt; <br /> <br />! <br />I' <br />/, <br /> <br />,~ <br /> <br /> <br />~~Lib~n\j <br /> <br />i, <br />.+- <br /> <br />H r,Or'J-O"-'/lcE!:lAU-:-OS <br />i ! <br /> <br />fG~GELtA!iILfTY <br />l.. J Ai~y "0TO <br /> <br />:>qoP[P"-Yr)AM"'G[ <br />We' '~'''~e~t: <br /> <br />" <br /> <br />1t::<CI!~,!:;L""'IU'r';' <br />i .---.!' :':110 L <br /> <br />1-1)!=oUCTIR!f' <br />~RE'tl'mO'j <br /> <br />V'-I.J!.;"'U-'-~L\'- d"u.~~N~ '~ <br />'OTHER EA"-~~ <br />i ALlie <br /> <br />j <br /> <br />.",,, <br /> <br />" ~.L'"'' ".'Ar.", <br /> <br />~^~W ~"'" ,~~C, ". <br />, '--~"~...~~~~._,,~'- <br />~ <br /> <br />WORIo<ERt COMPENSATION AND <br />i EMPLOYERS'llIlBIUTY <br /> <br />1,.GGRFG,4.,TEO <br />- <br />!- <br />I <br /> <br /> <br />I <br /> <br />, <br />.+~- <br />------j ; - <br />-- i:/IT=i <br />--~--':l <br /> <br />IOTI-iER <br /> <br />I cL.CACHACC::::U';] !$ <br />~~~.DI~EASE-=AEMPLU;~" -~-. <br />r--_m___n.._____,...____ <br />'I :)IS",,o.:;,. PC_ICYLlM'T <br /> <br />A I SEXUAL ABUSE <br /> <br />DESCRIPTION OF OpeAATlONSJlO(;ATIONSNEIiICLESlEXCLUSIONSAOOED BY ENOORSEMeNT/SPECIAL PROVISIONS <br />It is understood and agreed that the following entity is add~d as an <br />additional insured but only as respects the operations of the named insured <br />except tnat liabilit.l'" resulting from the additional insUJ::-eds sole negl.i.gence <br /> <br />100,000 <br />300,000 <br /> <br />CERTIFICATE HOLDER <br /> <br />I Y ADOltIONAl.lfllSU'U!O:INSUReA:LEnEA:: <br /> <br />CANCELLATION <br /> <br />CITYOFS <br /> <br />DATe tHEReOF. TH.E ISSUING JNSURER WiLL ENOEAVCi:;: TO MAll <br /> <br />SHOULt> jl,NY OF T;.;i! ABO"i; t.lSSCRlBEO POLIt.IES BE C.....CElli;O I5EF~E THE EXPIRJ,TIOK <br /> <br />City of Santa Ana <br />Pearl Raya <br />20 Civic Center Plaza <br />Sant~ Ana CA 92701 <br /> <br />t~OTICE TO Tl4E CERTIfiCATE HOLD!:R t-lAMED TO THE LEfT. nuT fAILURe TO 00 = SHAl..l. <br /> <br />10 OArSWRITT"rl <br /> <br />IMPOSE NO OBU"'ATtON OP. L!."Bl!..rn Of ."NY I<INO UPON THE IN5L'REFl. ITS AGENTS 0'" <br /> <br />Il!!ifP"lI=SENTATIVES <br /> <br />Jeffre E_ Frick <br />ACORD 2S-S (7/97) @ACORDCORPORATION1988 <br /> <br />---- <br />