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1 ORD iM- CERTIFICATE OF LIABILITY INSURANCE i AUG DATE 14 03 <br />AggR--DTM- <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />NATIONAL INSURANCE PROFESSIONALS CORP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />1040 NE HOSTMARK STREET #200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />POULSBOWA98370-7454 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />PHONE: (360)697.3611 <br />FAX: (360)697.3688 INSURERS AFFORDING COVERAGE NAIC # <br />_------ ------ -- -- --.— _----- --- _.d. <br />WSUREp INSURER A:_ UNITED NATIONAL INSURANCE COMPANY J <br />MENTAL HEALTH ASSOCIATION OF ORANGE COUNTY <br />INSURER B <br />822 TOWN AND COUNTRY ROAD <br />ORANGE CA 92868 INSURER C., <br />INSURER D� <br />A— a 003 — 059 INSURER E. <br />COVERAGES <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 <br />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 />IN TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY E>PI D TION <br />LIMITS <br />GENERAL U"UTY <br />I EACH OCCURRENCE S <br />COMMERCIAL GENERAL LIABILITY <br />�� CLAIMS MADE �� OCCUR <br />-- <br />MED.OEXP(AE�nyy OnITED on) $ <br />—, <br />I <br />PERSONALSADV INJURY 1$ <br />- <br />GENERAL AGGREGATE I$_ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG. Is <br />POLICY <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />(Ea acddenQ <br />ANY AUTO <br />ALL OWNED AUTOS <br />BODILY INJURY T <br />f — 7 <br />SCHEDULED AUTOS <br />(Per person) $ <br />HIRED AUTOSBODILY <br />--{ <br />INJURY $ <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE S <br />GARAGE LIABILITY <br />�I `rURM <br />AUTO ONLY -EA ACCIDENT s <br />-- <br />ANY AUTO APPROVE .'-:; 'J <br />OTHER'IL EAACC S <br />'� <br />AUTO ONLY: A $ <br />EXCESS/ UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />17 OCCUR CLAIMS MADE <br />AGGREGATE $ <br />L Ira SheedyDEDUCTIBL <br />--- <br />$ <br />Deputy City tto-n;cy <br />RETEN IONE $ <br />WORKERS COMPENSATION AND <br />W C STATU. OTHER <br />EMPLOYERS' LIABILITY <br />__. <br />ANY PWPRIETORIPARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT <br />OFFICERIMEMSER EXCLUDED? <br />E.L. DISEASE -EA EMPLOYEE T $ <br />SPECIAL PROVISIONS MIwi <br />E.L. E.L. DISEA�MIT I$ <br />OTHER: PROFESSIONAL LIABILITY CGAD44D49 AUG 8 03 1 AUG 8 04 <br />1$1,000,000 EACH CLAIM <br />A <br />$3,000,000 AGGREGATE <br />DESCRIPTION OF OPERATIONS/LOCATIONIVEHICLES/EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS <br />CERTIFICATE HOLDER TO BE NAMED AS ADDITIONAL INSURED UNDER THE ABOVE POLICY BUT ONLY AS THEIR INTERESTS MAY <br />APPEAR AND ONLY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. <br />CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER; CANICPI 1 ATIIM <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />20 CIVIC CENTER PLAZA <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br />PO BOX 1988 <br />FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />SANTA ANA, CA 92702 <br />INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />Attention: <br />Ba Clipsha <br />AGORD 25 (2001108) Certificate # 32030 <br />