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<br />r-~'C~~Dm <br /> <br />PROOUCER Imd INSURANCE BROKERS <br />P.O. BOX 17939 <br />ANAHEIM, CA 92817 <br />LICENSE # 0532703 <br />PHONE #(714) 688-1167 <br />RELAMPAGO DEL CIELO, INC. <br />BALLET FOLKLORICO <br />1010 W. MCARTHUS BLVD #22 <br />SANTA ANA, CA. 92705 <br />AX 949 794-0209 <br />COVERAGES <br /> <br />t:f - W02- <br />CERTIFICA"h:! OF LIABILITY INSUR~CE <br /> <br />DATE (MMfDDIYV) <br />09/17/02 <br /> <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />INSURED <br /> <br />SCOl'TSDALE INSURANCE COMPANY (VULClUl) <br /> <br />INSURER A: <br />INSURER B: <br />INSURER c: <br />i INSURER D: <br />INSURER E" <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />11~~I:lR T POLICY EFFECTive p~~~~y EXPIRATION ..- <br /> TYPE OF INSURANCE POUCY NUMBER LIMITS <br />A lOENERALLlAB'L1TY 1 CLS0806344 02/13/02 02/13/0 3 lEACH OCCURRENCE 1$ 1000000 <br />r il'COMMERClAL GENERAL LIABILITY I ' FIRE DAMAGE (Anyone fire) '$ 100000 <br /> I I ClAIMS MADE [JCJ OCCUR MED EXP (Anyone person) $ 5000 <br /> jd PERSONAL & ADV INJURY $ 1000000 <br /> GENERAL AGGREGATE $ 1000000 <br /> GEN'LAGGREF LIMIT AP~; PER: i PRODUCTS - COMP/OP AGG $ 1000000 <br /> Xl POLICY ~~RT 'I LOC I <br /> AUTOMOBILE L1ABIL.ITY COMBINED SINGLE L.IMIT <br />R ANYAUTO (Eaaccident) .$ <br /> I <br />H' ALL OWNED AUTOS -, <br /> BODILY INJURY 1$ <br />f--: SCHEDULED AUTOS (Per person) <br /> . I ----- <br />I. HIRED AUTOS BODILY INJURY ! <br /> (Per accident) $ <br /> NON-OWNED AUTOS <br />H- -- <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE L.IABILlTY AUTO ONLY - EA ACCIDENT $ ...- <br /> --l ANY AUTO OTHER THAN EAACC $ <br /> AUTO ONLY AGO $ <br /> EXCESS LIABILITY EACH OCCURRENCE $ .- <br />i:::J-OCCUR D CLAIMS MADE AGGREGATE $ .- <br />A1"rKO,ED AS 10 FORM $ <br /> ?J I -. ,,--- <br />iC1,DEDUCTIBLE 1/, $ <br /> ;;(;z d .0. 9L ^ L/ - -- - -- -- <br />j' RETENTION $ 1$ <br />i WORKERS C'()MPI<"~jr.;f.T!ON AND Laura Sheedy I / ~rCSTATU- I IOTH- <br /> EMPLOYERS'L.IABILlTY ruBY LIMITS ' ER _I ~.._'- <br />I D"::pl1ty City Attorney E L. EACH ACCIDENT------!--! _,_____ ---- <br /> EL. DISEASE - EA EMPLOYEE $ - <br /> EL. DISEASE - POLICY LIMIT $ <br />X OTHER <br /> 10 DAY CANCEL <br />~ON PAYMENT. <br />DESCRIPTION OF OPERATIONS/L.OCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL. PROVISIONS <br />RE: THE CITY OF SANTA ANA ITS OFFICERS AGENTS, EMPLOYEES AND VOLUNTEERS ARE <br />NAMED AS ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN CONNECTION WITH <br />THE NAMED INSURED. <br />CERTIFICATE HOLDER Ix I ADDITIONAL. INSURED; INSURER LmER: CANCELLATION . <br /> SHOULD ANY OF THE ABOVE DESCRIBED POL.ICIES BECANCELL.ED BEFORETHE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL! MAIL. d..!L DAYS WRITTEN <br /> CITY OF SANTA ANA COMMUNITY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, L <br /> DEVELOPMEII'r AGENCY (M-25) .". ... OR <br /> 20 CIVIC CEII'rER PLACE <br /> SANTA ANA, CA 927Dl ES. <br /> AUTHORIZED REPRESENTAfE ~\\ 'w ~ Q <br /> A't'TNI JOHN MALONEY <br /> JACK L. SMITH '" -...P?:. 'r':: -.... <br />ACORD 25-5 (7/97) \ '" ACO'Rl> CORPORATION 19B8 <br />