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A-aOD3,0U5 Fax M. <br />.;A-2002 P.Dogi-3`/6 <br />4 y .-PLil-2003 THU 04:09 PH �. <br />AGORD CERTIFICATE OF LIABILITY INSURANCE <br />ISU Ins Sry - Fullerton Agency <br />1150 E Orangethorpe Avo,R101 <br />Placentia CA 92870 <br />Phone:714-577-5800 Faxi714-577-50ee <br />Womenls Transitional Living <br />Center <br />i P.O- Box 6103 <br />Orange CA 92863 <br />COVERAGES <br />THE PUU-2OrINSUDANCE LISTED UCL OW I(AVE BEEN ISSUED 10 THE UISUR DNAMED <br />ANY REQUIREMENT, TERM OR CON0111(W Of ANY CONTIW,T OR O'MER DOCUMENT W -, " <br />MAY PFR fMN, AIE w9Uw CFArrORPGODYIMEPDIICII.5OESCRI;IFD}ICRGINISSUPJEI <br />5{rLO)4(,,PF5 ACGREGAIC LIMIT S SHOYN MAY HAVE BEEN RT DUCCO by P=CL:•IMs <br />LTA Itt]R� TYPE OK INSUMNCf I -,— POLICY NUMBER <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED DY THE POLICIES 9ELOW. <br />INSURERS AFFORDING COVERAGE NAIL k <br />raur .A. Philadelphia Insurance Comn..ny_ <br />Post -it" Fax Note 7671 <br />F 7 <br />T <br />Colonvt. <br />from �' <br />co, <br />Pnono 0 <br />PHOne'ji <br />Fox <br />Fa'gU <br />GENERAL LIABILITY <br />IEACH <br />OCC'JRRCI+CE WSJ <br />OOO,OOO^ <br />A <br />X GnMmcragl. GENERALIIANILRy <br />pHPK022342 04/04/03 <br />I <br />04 /04/04 <br />PREMISE;-(Foumarpcat <br />s100_OOD _ <br />IX <br />I .,AIMS MAOL LI oCCUN <br />MLO Fx"'A MODeI"m)55_D <br />DD <br />-XTpr_o_f Li. <br />PCRSOHAL B AOVMJURy <br />- <br />$$GOO, DDO <br />CENCRAL AGGREGATE ( <br />$ 2 , 000 , 000 <br />GEN'L AGGREGATE LIMIT APPUES PEP. <br />PRODUCTS-6OMP701` AGG <br />..._—.._-.. <br />i f BOO O , D O OJ <br />POI.ICY JC� LOC <br />,AUTOMODILE <br />LWa1LITY <br />BINE LUAIT <br />'1 000,OOD <br />A <br />�ANYAUTO <br />PHP9022342 <br />04/04/03 <br />04/04/04 <br />(Ea=66DSINGLE <br />(Ea l<riaonq <br />r <br />ALL OWNED Ab1OG <br />OODILY fNJNIY <br />SCIILDULCD AUTOS <br />iPnrpur=n),—' <br />$ <br />• <br />1 $ <br />HINEDALROS <br />"}Ci FO <br />iV1 <br />SODILYMNRY <br />,�-- <br />S <br />X <br />NON OWNED AUTOS <br />OV'Gil .�� <br />_..�...— <br />_....--._ <br />(RuoPFRiY AGEF� <br />_ <br />GARgGE 114BIUry <br />ANYADTo y,( uru <br />^--^' <br />Saezlly <br />AU fOONLY-EA ACCI OCNI <br />OTNhM1 TURN F.AnCC <br />i <br />-. --... <br />i <br />r14{ <br />PA <br />(%1{V iX LLO CT1ey <br />AVID ONLY. ACV <br />$-----_--- <br />EXCESSNMBRELLA LIAmUTY <br />X r_ OCCUR CINh1G MAOE <br />DCOUCTBILE <br />RETCN1IUN 5 <br />WORKERS COMPENSATION AND <br />EMPLOYERS' UABILITY <br />ANY PR01'RIETONmARTNER/EXECUTIVE- <br />OF(ICER/MCIAMERGXCLUOFD? <br />��A Property IPHFK022142 <br />$ <br />EI EACH ACCID[f.t T _ _ . <br />E.L Ol$EgSC-fJ. El1PL0'ICG`8— �— <br />EL.DIS.'.nSE-POLICY <br />04/04/03� 04/04/04� Building 2,4000,000 <br />1 Contents 150.00 <br />City of Santa Ana, its officers, agents eJLPloyses and volunteers are namad <br />as additional insured as zespocts to their interest in connection with the <br />namad insured. Addit'l insured as respects to goner'al liability per form <br />attached to pol. This pal is primary 6 is not additional to or coatrihuting <br />w/ any other insurance *except for gross negligence and willful misconduct. <br />C15Ax$r SHOULD ANY Or THE ABOVE OUjNA-En <br />E CANCELLED BCPORG ME EXPIRATIO.' <br />DATE TNERCOp• THE ISSUING LNVOB TO MAIL 30* DAYSWRITTEN <br />City Of Santa Ana-CDBG M-25 NDTK;E TO THE CERTIFI^ATE HE LEFT, F4fi�F ft*In k+CitiCommunity Development AgoncySIR <br />Ca%la ThompkinaP.O. Box 1988 M-25 �� _Santa Ana CA 92702AUTNOR¢ED Rerr:EseNTATIveL-Q� i <br />ACORD 2S 12001108) QACORD COR ORATION 1988 <br />