CAMBODIAN FAMILY, THE 2 - Laserfiche WebLink

Home Browse Search

CERTIFICATE OF D LIABILITY INSURANCE 004 M PRODUCER 714)838 -1912 FAX (714)838 -7568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lake Insurance Agency ONLY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Li c #0747473 INSURERS AFFORDING COVERAGE NAIC # Tustin, CA 92780 INSURED Cambodian Family X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR INSURERA Philadelphia Ind. Ins. Co. INSURER B: MED EXP (Any one person) 1111 East Wakeham Avenue PERSONAL& AUV INJURY INSURER C: A Suite E X 0 deductible INSURER D: Santa Ana, CA 92705 GENERAL AGGREGATE INSURER E: COVERACitS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR NSR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER PHPK074625 DATE MMlDDlYV 03/09/2004 DATE MM /DD/YY 03/09/2005 LIMITS EACH OCCURRENCE $ 1 000 DDO PREMISES Ea occurence $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL& AUV INJURY $ 1,000,000 A X 0 deductible GENERAL AGGREGATE S 3,000,000 PRODUCTS - COMP /OP AGG $ included GEN -L AGGREGATE -LIMIT APPLIES PER: X POLICY PE OC AUTOMOBILE LIABILITY ANY AUTO PHPK074625 03/09/2004 03/09/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ A HIRED AUTOS X X NON -OWNED AUTOS - $0 Deductible PROPERTY DAMAGE (Per accident) $ X GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGO $ ANY AUTO S EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE $ OCCUR CLAIMS MADE `.. S DEDUCTIBLE RETENTION $ -1 2 $ $ WORKERS COMPENSATION AND .. -. - -'' ... - TORY LIMITS ER I I E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? `' _ - - E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes describe under SPECIAL PROVISIONS below - A OTHER Abuse & Molestation PHPK074625 03/09/2004 03/09/2005 $1,000,000 Each Claim $3,000,000 Aggregate $0 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Employee Dishonesty Liability $200,000 / 0 Ded. ertificate holder is named as additional insured per contract with named insured. Schedule of vehicles and drivers on file. '°10 day notice of cancellation due to non - payment of premium. CERTIFICATE HOLDER GANGtLLA I iON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL X MAIL *10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Santa Ana Work Center XXx�Xxy��ppl�pXgl�XpXXX 1000 Santa Ana Blvd., Suite 200 K*irA9PiC)W1KXM%MXIXXXXXM)QKX 3CmXXXXXXX X Santa Ana, CA 92701 A" ZED D ' .1 ©ACORD ACORD 25f(2001108)