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ACOaRDATE <br />CERTIFICATE OF LIABILITY INSURANCE <br />IMNm WYYYV) <br />1 09/11/2003 <br />PRODUCER (714)838 -1912 FAX (714) 638 -7568 <br />CAM -BMR Insurance Agency <br />P.O. Box 102S <br />Tustin, CA 92781 <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 />INSURERS AFFORDING COVERAGE <br />NAIC 0 <br />INSURED Cambodian Family <br />1111 East Wakeham Avenue <br />Suite E <br />Santa Ana, CA 92705 �, yb ✓�o�7 -V I <br />3- I 5 <br />INSURER& Philadelphia Indemnity Ins. Co. <br />PO EFFE OVE <br />INSURER B: <br />UMI13 <br />INSURER C. <br />INSLWERO <br />PHPK043151 <br />INSURER E: <br />03/09/2004 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTLMTHSTANDIN( <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TOM ICH THIS CERTIFICATE MAYBE 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 />INSR <br />113L <br />ADD't <br />h= <br />TYPEOPINSURANCE <br />POLICY NUMBER <br />PO EFFE OVE <br />POLIC711011%9`4 <br />UMI13 <br />GENERAL LIABIUW <br />PHPK043151 <br />03/09/2003 <br />03/09/2004 <br />EACHOCCURRENCE <br />f 1,000,00( <br />X COMMERCIALGENERALUABIUTY <br />DAMAGETORENTED <br />f 400.00 <br />CLAIMS MADE Fx] OCCUR <br />$ 5,00( <br />MED EXP (MS. pdn.n) <br />A <br />X Abuse/Molestation <br />PERSONAL AADV INJURY <br />$ <br />1,000,00( <br />GENERAL AGGREGATE <br />S 11000.00 <br />OENL AGGREGATE LIMIT APPLIES PER; <br />X POLICY JET LOC <br />PRODUCTS -COMPIOP AGO <br />! include <br />AUMMOatt <br />LIAA ITY <br />ANY AUTO <br />PHPK0431SI <br />09/01/2003 <br />03/09/2004 <br />COMBINED SINGLE LIMB <br />1ESY ft) <br />S <br />1,000,00C <br />BODILY INJURY <br />IPK Wnon) <br />! <br />A <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />HREDAUTOB <br />WN <br />NONAED AUTOS <br />X <br />X <br />BOOILYINJ) <br />IPV ACTJaRM <br />S <br />X <br />Hired Phys Dam. <br />X <br />PROPERTY DAMAGE <br />(P. Rcdd") <br />f <br />X <br />10000m/1000co11 <br />GARAGE LABILITY <br />AUTO ONLY - EA ACCIDENT <br />S <br />ANY AUTO <br />/ \."i li <br />: <br />�' �� L.. 1U <br />i`�''" <br />1'(i l \;:v <br />OTHER THAN EA ACC <br />AUTOONLY: AGG <br />! <br />S <br />EXCESS&WBKMLA UIBEJTY <br />OCCUR CLAIMS MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />$ <br />S <br />DEDUCTIBLE <br />f <br />RETENTION 3 <br />S <br />WORNERSCOMPEHSATIONAND <br />WC AT U- OTH- <br />EMPLOYER 11.11 NTY <br />E.L. EACH ACCIDENT <br />S <br />ANY PROPRIETOUPARTNERIEXECUTIVE <br />OFFICERNEMBER EXOLUDE07 <br />It <br />SXyW Owalb, InBEr <br />SPECIAL PROVISIONS DMOP <br />E.L DISEABE - EA EMPLOYE <br />3 <br />E.L. DISEASE - POLICY LIMIT <br />f <br />A <br />oTHEnRercial Crime / <br />mployee Dishonesty <br />PHPK0431SI <br />09/05/2003 <br />03/09/2004 <br />Limit: $200,000 / Ded $2,500 <br />I-WSORIPnON OP OPERATIONS I LOCATIONS I VEHICLES I EICLIISH)NS ADDED BY ENOORSEMENT/ S►ECVIL PROWSIONS <br />e 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 />The City of Santa Ana <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />ACORD 26 (2001/08) <br />SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />ID RUUIDON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />+30�TDAYS WRTTEN NOTICETO THE CERTIFICATE HOLDER "MOM THE LEFT, <br />BIp'1rA1LURE 70 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OACORD CORPORATION 1988 <br />. 1 1 ./I' <br />