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ind !r NoC <br />[mill <br />}VIV I11 <br />• • •' <br />ININIIIIIIIII IIIN■N■11 ■II <br />NAME AND ADDRESS OF AGENCY <br />COMPANY <br />GREAT RTCAN.—INSURANCE _COhP.AN1 - -._. <br />NANCARROW INSURANCE AGENCY <br />Effective 12:01am 9/24/ 19 82 <br />1400 N. HARBOR BOULEVARD #640 <br />Expires E 12:01 am ❑ Noon 10L24 82 <br />FULLERTON, CALIFORNIA 92635 <br />....?_9 <br />D This binder is issued to extend coverage in ':he af: ove narned <br />company per expiring policy # <br />(except as noted t ciawi _ <br />NAME AND MAILING ADDRESS OF INSURED <br />Description of Opersition /Vehicles / Propperty <br />SOUTHWEST SANTA ANA LITTLE LEAGUE, INC <br />& SANTA ANA POP WARNER FOOTBALL, INC. <br />CONCESSION STAND <br />2100 SOUTH FLOWER, MEMORIAL PARK <br />SANTA ANA, CALIFORNIA <br />Type and Location of Property <br />Coverage /Perils /Fbims Amt of Insurance fined. c� <br />P <br />R <br />BUILDING COVERAGE FOR CONCESSION <br />0 <br />STA14D LOCATED IN MEMORIAL PARK <br />"ALL <br />RISK" <br />40,000 <br />500 <br />90% <br />P <br />E <br />R <br />T <br />Y <br />Type of Insurance <br />Coverage /Forms <br />_ Limits of Liability <br />Each occurrence Aggregate <br />L <br />_ <br />Scheduled Form D Comprehensive Form <br />_ -- <br />Bodily Injury <br />$ <br />$ <br />A <br />B <br />$XPremises /Operations <br />Property <br />I <br />❑ Products/ Completed Operations <br />Damage <br />$ <br />$ <br />-_ <br />❑ Contractual <br />I <br />El <br />Property <br />5nD,_ono <br />T <br />D Mted. Payyecif$below) <br />$ <br />$ <br />L, DO 000- _ 5 <br />r <br />r�Per Aamre�t <br />D Personal Injury <br />DA <br />D B D C <br />Personal Injury $ <br />Limits of Liability <br />A <br />U <br />D Liability D Non owned D Hired <br />Bodily Injury (.Each Person) $ <br />T <br />D Comprehensive Deductible $ <br />Bodily Injury (Each Accident) $ <br />0 <br />D Collision - Deductible $ <br />Property Damage $ <br />M <br />0 <br />D Medical Payments $ <br />B <br />D Uninsured Motorist $ <br />1 <br />D No Fault (specify): <br />Bodily Injury 1L Property Damage <br />L <br />D Other (specify): <br />Combined $ <br />El <br />I <br />D WORKERS' COMPENSATION — Statutory Limits (specify states below) D EMPLOYERS' LIA131LITY — Limit $ <br />SPECIAL CONDITIONS /OTHER COVERAGES <br />30 DAY NOTICE OF CANCELLATION, <br />NONRENEWAL, ETC. <br />NAME AND ADDRESS OF D MORTGAGEE D LOSS PAYEE: XXADD'L INSURED <br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES <br />AND AGENTS LOAN NUMBER <br />C/O CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA. 92702 <br />9/29/82 <br />Signature of uthonied Representative Date <br />ACORD 75 (11 -77) <br />