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w <br /> <br />ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMMRXNYYYY) <br />09/11/2003 <br />vxooucER (714)838-1912 FAX (714)838-7568 <br />CAM-BMR Insurance Agency <br />P. 0. Box 102 S 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 />Tustin, CA 92781 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED Ca O lan Family INSURERA: Phll ddelphla Indemnity Ins. CO. <br />1111 East Wakeham Avenue INSURER B: <br />Suite E 7 <br />~' <br />~ INSURER C: <br />Santa Ana, CA 92705 <br />b <br />J~ <br />O <br />~~-O~ INSURER D: <br />~? <br />/ <br />~~ <br />//yy <br />/ <br />v`vv~J- ~ (Q 5 INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD' rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY E%PIRATION LIMITS <br /> GENERAL LIABILITY PHPK043151 03/09/2003 O3/O9/2004 EACH OCCURRENCE $ 1 OOO OO <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED E 4OO OO <br /> CLAIMS MADE ®OCCUR MED EXP (Any one person) E S OO <br />A X Abuse/Molestation PERSONALBADVINJURY E 1 OOO,OO <br /> GENERAL AGGREGATE E 1 OOO OO <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E include <br /> X POLICY PRO LOC <br />JECT <br /> AUT OMOBILE LNBILITY PHPK043151 09/01/2003 03/09/2004 coMBINED SINGLE LIMIT <br /> <br />ANY AUTO <br />(Ee emtlelM1) E <br />1 OOO , OO <br /> ALL OVrNED AUTOS <br />BODILY INJURY <br />E <br />A X SCHEDULED AUTOS (Per parson) <br /> X HIRED AUTOS <br />BODILY INJURY <br />E <br /> X NON-OVvNED AUTOS (Per eccitleM) <br /> X Hired Ph <br />s Dam <br /> y <br />. PROPERTY DAMAGE <br /> X 100com/1000co11 (Per eputlsm) E <br /> GARAGE LWBILITY AUTO ONLY-EA ACCIDENT E <br /> ANY AUTO /y,'1 ti ~~~ [~iJ 1 ~ I'(e`hhe OTHER THAN EA ACC f <br /> AUTO ONLY: AGG S <br /> EXCESSNMBRELLA LIABILITY EACH OCCURRENCE S <br /> OCCUR CLAIMS MADE <br />' AGGREGATE S <br /> „ <br />E <br /> DEDUCTIBLE ~ - ' ~ - ' E <br /> RETENTION S S <br /> WORKERS COMPENSATION AND <br />' VIC STATU- OTH- <br /> EMPLOYERS <br />LIABILITY " <br /> ANV PROPRIETOR/PARTNER/E%ECUTIVE E.L. EACH ACCIDENT E <br /> OFFICERIMEMBER EXCLUDED? <br />E.L. DISEASE-EA EMPLOYE <br />E <br /> If yes, tlesniEe untler <br /> SPECIAL PROVISIONS EeloN E.L. DISEASE -POLICY LIMIT E <br /> ommercial Crime / PHPK043151 09/05/2003 03/09/2004 Limit: 5200,000 / Ded 52,500 <br />A mployee Dishonesty <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSKINH ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />he Santa Ana Empowerment Corporation and The City of Santa Ana are named as <br />dditional insured's as respects the additional insured endorsement attached. <br />Subject to 10 days notice of cancellaiton due to non-payment of premium. <br />SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIMTION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR 70 MAIL <br />The City of Santa Ana <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />ACORD 25 (2001/05) <br />NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT, <br />TO MAIL SUCH NOTICE SHAn~LIL IMPOSE NO OBLIGATION OR LUBILITY <br />UPON TNB INSURER ITS AOENT9 OR REPRESENTATNES. <br />®ACORD CORPORATION 1988 <br />7 cr~a-- <br />